Pr. Nicholas Turner
The Institute of Cancer Research (UK)

What is TRAKER study, its purpose, technology used?

The TRAK-ER study will study the potential benefits of molecular relapse monitoring with circulating tumour DNA (ctDNA) assays in patients with ER positive HER2 negative breast cancer on adjuvant endocrine therapy. We have no way of adequality following these patients for future relapse. In the study we will offer patients, with higher risk disease, surveillance with personalised ctDNA assays. Those with a molecular relapse will be randomised between continuing standard adjuvant endocrine therapies and switching to palbociclib and fulvestrant. The aim of the study is to show that switching to palbcocilib and fulvestrant at the time of molecular relapse can delay metastatic relapse, and perhaps we can hope prevent a relapse in some patients.

How was the collaboration between the French and English centers born?

The TRAK-ER collaboration was born out of a shared interest between Unicancer and French PIs on one hand, and the Royal Marsden team and UK PIs on the other, to address the important question of whether molecular relapse monitoring can improve outcome for patients. The study will recruit up to 1100 patients into ctDNA surveillance, so combining our efforts is vital to answering this question for our patients.

Do you think that personalized follow-up could be considered in the future in standard practice?

The TRAK-ER study is going to be a leading international study to address whether molecular relapse monitoring has clinical utility. Although we know that ctDNA detection predicts for future relapse with high accuracy, we don’t know if treating people at the point of ctDNA detection – molecular relapse – can improve outcome. If TRAK-ER results are as we hope, such monitoring could become the standard of care in the future.