The ZEST clinical trial aimed to evaluate niraparib for preventing breast cancer recurrence in patients with ctDNA, but failed due to low patient enrolment. Lessons learned include starting ctDNA testing during treatment, including high-risk patients to increase ctDNA-positive cases, and intervening promptly with appropriate therapies for MRD. Detecting ctDNA post-treatment is crucial for preventing recurrence. The trial saw only 147 eligible out of 1,901 patients with detectable ctDNA. Patients with detectable ctDNA had higher recurrence rates. Future trials should start ctDNA testing earlier and focus on high-risk patients to improve outcomes. While study results on niraparib efficacy were inconclusive due to low enrolment, insights from this trial will inform future trial design.
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ZEST trial fails to meet enrollment goals for ctDNA testing in breast cancer
