进行临床试验所需的时间限制了我们评估并向癌症患者提供新治疗方案的速度。在保持严谨性的同时提高试验效率的新方法将使患者受益，特别是在肿瘤学领域，其中辅助试验有望阻止转移性疾病，但通常需要大量患者和多年才能完成。我们设想建立一个常设平台——一个基础设施，用于支持在早期癌症的治疗性治疗后，根据循环肿瘤 DNA 的存在，对具有疾病早期分子证据 (MED) 的癌症患者进行持续识别和试验登记。 MED 强烈预测随后的复发，绝大多数患者在 18 个月内显示出疾病的放射学证据。这样的平台将允许对许多治疗方法进行有效的测试，从小型探索性研究到更大规模的关键试验。招募 MED 患者但没有疾病影像学证据的试验有可能推进药物评估，因为与传统辅助试验相比，它们可以更小（考虑到复发概率高）和更快（考虑到复发时间短）。循环肿瘤 DNA 还可能提供治疗效果的有价值的早期生物标志物，这将允许进行小型信号发现试验。在本视角中，我们讨论如何建立这样一个平台。© 2024。施普林格自然有限公司。

The time required to conduct clinical trials limits the rate at which we can evaluate and deliver new treatment options to patients with cancer. New approaches to increase trial efficiency while maintaining rigor would benefit patients, especially in oncology, in which adjuvant trials hold promise for intercepting metastatic disease, but typically require large numbers of patients and many years to complete. We envision a standing platform - an infrastructure to support ongoing identification and trial enrolment of patients with cancer with early molecular evidence of disease (MED) after curative-intent therapy for early-stage cancer, based on the presence of circulating tumour DNA. MED strongly predicts subsequent recurrence, with the vast majority of patients showing radiographic evidence of disease within 18 months. Such a platform would allow efficient testing of many treatments, from small exploratory studies to larger pivotal trials. Trials enrolling patients with MED but without radiographic evidence of disease have the potential to advance drug evaluation because they can be smaller (given high probability of recurrence) and faster (given short time to recurrence) than conventional adjuvant trials. Circulating tumour DNA may also provide a valuable early biomarker of treatment effect, which would allow small signal-finding trials. In this Perspective, we discuss how such a platform could be established.© 2024. Springer Nature Limited.