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01.
arXiv (CS.LG) 2026-06-12

Design Criteria for SGD Preconditioners: Local Conditioning, Noise Floors, and Basin Stability

arXiv:2511.19716v2 Announce Type: replace-cross Abstract: Stochastic Gradient Descent (SGD) often slows in the late stage of training due to anisotropic curvature and gradient noise. We analyze preconditioned SGD in the geometry induced by a symmetric positive definite matrix $\mathbf{M}$, deriving bounds in which both the convergence rate and the stochastic noise floor are governed by $\mathbf{M}$-dependent quantities: the rate through an effective condition number in the $\mathbf{M}$-metric, and the floor through the product of that condition number and the preconditioned noise level. For nonconvex objectives, we establish a preconditioner-dependent basin-stability guarantee: when smoothness and basin size are measured in the $\mathbf{M}$-norm, the probability that the iterates remain in a well-behaved local region admits an explicit lower bound. This perspective is particularly relevant in Scientific Machine Learning (SciML), where achieving small training loss under stochastic updates is closely tied to physical fidelity, numerical stability, and constraint satisfaction. The framework applies to both diagonal/adaptive and curvature-aware preconditioners and yields a simple design principle: choose $\mathbf{M}$ to improve local conditioning while attenuating noise. Experiments on a quadratic diagnostic and three SciML benchmarks validate the predicted rate-floor behavior.

02.
arXiv (CS.CL) 2026-06-12

Language Model Circuits Are Sparse in the Neuron Basis

The high-level concepts that a neural network uses to perform computation need not be aligned to individual neurons (Smolensky, 1986). Language model interpretability research has thus turned to techniques which decompose the neuron basis into more interpretable units of model computation, such as sparse autoencoders (SAEs). However, not all neuron-based representations are uninterpretable. For the first time, we empirically show that MLP neurons are as sparse a feature basis as SAEs. We use this finding to develop an end-to-end gradient-based attribution pipeline for circuit tracing on the MLP neuron basis, which surfaces causally effective neurons on a variety of tasks. On a standard subject-verb agreement benchmark (Marks et al., 2025), a circuit of $\approx 10^2$ MLP neurons is enough to control model behaviour. On the multi-hop city-state-capital task from (Lindsey et al., 2025), we find a circuit in which small sets of neurons encode specific latent reasoning steps (e.g. mapping a city to its state), and can be steered to change the model's output. This work thus advances automated interpretability of language models without imposing additional training costs.

03.
arXiv (CS.AI) 2026-06-16

Prediction Bottlenecks Don't Discover Causal Structure (But Here's What They Actually Do)

arXiv:2605.09169v2 Announce Type: replace-cross Abstract: A Mamba state-space model trained only for next-step prediction appears to recover Granger-causal structure through a simple readout $S = |W_{out} W_{in}|$, with early experiments suggesting the phenomenon generalized across architectures and benefited from interventional data at $p < 10^{-5}$. We package the protocol used to test that claim – standardized synthetic generators (VAR/Lorenz/CauseMe-style), three intervention semantics ($do(X=c)$, soft-noise, random-forcing), edge-provenance cards on three real datasets, and size-matched control arms – as a reusable falsification benchmark, and walk the claim through it in five stages. The method-level claim does not survive: (i) a plain linear bottleneck does as well or better; (ii) tuned Lasso beats the bottleneck on synthetic CauseMe-style benchmarks, and on Lorenz-96 (the only real benchmark with unambiguous ground truth) classical PCMCI and Granger lead a tight cluster in which the bottleneck trails; (iii) the headline intervention advantage is roughly 60% a sample-size confound, and the residual disappears under standard $do(X=c)$ interventions, surviving only under a non-standard random-forcing scheme; (iv) even that residual reproduces, with a larger effect, in classical bivariate Granger – the effect is method-agnostic. What survives is a narrow characterization result; the benchmark is the lasting artifact, and each stage above is one of its control arms.

04.
arXiv (math.PR) 2026-06-12

Non-commutative Law of iterated logarithm

arXiv:2509.22037v2 Announce Type: replace-cross Abstract: We prove optimal non-commutative analogues of the classical Law of Iterated Logarithm (LIL) for both martingales and sequences of independent (non-commutative) random variables. The classical martingale version was established by Stout [Sto70b] and the independent case by Hartman-Wintner [HW41]. Our approach relies on a key exponential inequality essentially due to Randrianantoanina [Ran24] that improves that from Junge and Zeng [JZ15]. It allows to derive an optimal non-commutative Stout-type LIL just as in [Zen15], from that martingale result we then deduce a non-commutative Hartman-Wintner type LIL for independent sequences of random variables.

05.
arXiv (CS.AI) 2026-06-15

Hidden in Plain Sight: Benchmarking Agent Safety Against Decomposition Attacks with DECOMPBENCH

arXiv:2606.13994v1 Announce Type: cross Abstract: LLM-based Agents are becoming increasingly capable and widely deployed, creating growing incentives for adversarial misuse in the real-world. A key emerging threat is Decomposition Attacks [glukhov2024breach, jones2024adversaries] in which a harmful task is broken into simpler, benign subtasks that evade safety mechanisms when executed separately but cumulatively fulfill the malicious intent. Although recent benchmarks assess agent safety in multi-turn and multi-tool-use settings, they do not explicitly capture this form of decompositional misuse and may not represent realistic adversarial execution flows. To this end, we introduce DeCompBench, a benchmark designed specifically to evaluate agentic safety under decomposition attacks. DeCompBench is created with a decomposition-by-design principle using a graphical framework and enables harmful task decomposition into individually benign and executable subtasks with realistic workflows. Our experiments using a custom decomposer show that state-of-the-art agents exhibit high refusal rates on monolithic harmful tasks, but significantly lower refusal rates on their decomposed variants, while often inadvertently fulfilling the adversarial objectives. These findings underscore the need for safety evaluations against decomposition attacks and corresponding defenses. Our dataset is publicly available and can be found at https://huggingface.co/datasets/decompositionbench/DeCompBench.

07.
arXiv (CS.CV) 2026-06-17

Principled RL for Flow Matching Emerges from the Chunk-level Policy Optimization

Recent Progress in post-training flow matching for text-to-image (T2I) generation with Group Relative Policy Optimization (GRPO) has demonstrated strong potential. However, it is hindered by a critical limitation: inaccurate advantage attribution. In this work, we argue that aggregating consecutive steps into a coherent 'chunk' and shifting the policy optimization paradigm from GRPO's step level to the chunk level can effectively mitigate the negative impact of this issue. Building on this insight, we propose Group Chunking Policy Optimization (GCPO), the first chunk-level reinforcement learning approach for post-training flow matching. Extensive experiments demonstrate that GCPO achieves superior performance on both standard T2I benchmarks and preference alignment, with up to 43% relative gains over GRPO, highlighting the promise of chunk-level policy optimization. The code is available on https://github.com/xingzhejun/GCPO.

08.
arXiv (CS.CL) 2026-06-17

LLM Features Can Hurt GNNs: Concatenation Interference on Homophilous Graph Benchmarks

Adding LLM-generated node features to graph neural networks (GNNs) is widely reported to improve accuracy on standard benchmarks. We document a contrasting observation: when LLM features are introduced through pure input concatenation (rather than joint training, distillation, or prompt-conditioning), they can systematically degrade accuracy on the same homophilous benchmarks where end-to-end LLM pipelines succeed. With an MLP backbone on the Planetoid public split and bag-of-words original features, concatenating SBERT-encoded GPT-4o-mini TAPE features reduces PubMed test accuracy by -17.0 +/- 0.3 pp and Cora by -4.3 +/- 0.6 pp (CiteSeer -0.6 +/- 0.8 pp, within seed noise). The drop attenuates as we relax each condition (GCN / GCNII / GAT backbones, random splits, smaller encoders) and reverses on medium-homophily WikiCS (+4.4 pp) and ogbn-arxiv (+11.7 pp). To predict when concatenation helps versus hurts, we report a simple measure of LLM-alone discriminability, Delta_sig. Across 9 datasets Delta_sig correlates with the concatenation cost more strongly than homophily at point estimate (r^2 = 0.38 vs. 0.06; N=9, bootstrap CIs overlap). The bootstrap-best change-point is tau = 13.8 pp, and the rule "Delta_sig

09.
arXiv (CS.CV) 2026-06-24

Fine-Grained Open-Vocabulary Object Detection with Fined-Grained Prompts: Task, Dataset and Benchmark

Open-vocabulary detectors are proposed to locate and recognize objects in novel classes. However, variations in vision-aware language vocabulary data used for open-vocabulary learning can lead to unfair and unreliable evaluations. Recent evaluation methods have attempted to address this issue by incorporating object properties or adding locations and characteristics to the captions. Nevertheless, since these properties and locations depend on the specific details of the images instead of classes, detectors can not make accurate predictions without precise descriptions provided through human annotation. This paper introduces 3F-OVD, a novel task that extends supervised fine-grained object detection to the open-vocabulary setting. Our task is intuitive and challenging, requiring a deep understanding of Fine-grained captions and careful attention to Fine-grained details in images in order to accurately detect Fine-grained objects. Additionally, due to the scarcity of qualified fine-grained object detection datasets, we have created a new dataset, NEU-171K, tailored for both supervised and open-vocabulary settings. We benchmark state-of-the-art object detectors on our dataset for both settings. Furthermore, we propose a simple yet effective post-processing technique. Our data, annotations and codes are available at https://github.com/tengerye/3FOVD.

10.
arXiv (CS.AI) 2026-06-16

UXBench: Measuring the Actionability of LLM-Generated UX Critiques

arXiv:2606.16262v1 Announce Type: cross Abstract: Large language models (LLMs) are increasingly deployed as UX judges that inspect interfaces, diagnose usability problems, and propose repairs. Yet no controlled benchmark measures whether the resulting critiques are reliable and actionable across heterogeneous product surfaces. We introduce UXBench, a benchmark for evaluating LLMs as interaction-grounded UX judges. UXBench comprises local-first runnable web fixtures spanning ten product-surface families, paired with coverage-gated browser exploration that forces models to collect interaction evidence before reporting. Each judge model produces a structured UX report over seven rubric dimensions; report quality is measured by whether a fixed downstream repair agent can improve the interface based on the critique. We evaluate eight frontier models under both an automated repair-lift protocol and a blind human validation study. Results show that UX judging is neither saturated nor one dimensional: models differ meaningfully in report actionability, exhibit distinct rubric-level repair signatures, vary in fixture-level reliability, and trade leadership across surface categories

11.
medRxiv (Medicine) 2026-06-17

The Unreliable Judges: Assessing Reproducibility and Self-Preference Bias of LLMs as Free-Text Evaluators

Large Language Models (LLMs) are transforming clinical practice and research, but their adoption requires rigorous evaluation. While human assessment is ideal, its cost has driven the widespread use of LLMs as evaluators. We introduce an open-source reciprocal framework comparing 71 human experts against six LLMs. AI evaluators show a strong self-preference bias, yet neither group reliably identified whether a response was human- or AI-generated. AI scores correlated with surface features such as length and lexical diversity, whereas human scores did not. By probing the evaluator's hidden states and applying targeted steering, we show that verbosity is a major causal driver of the bias. Moreover, shuffling question-response pairings shows that long responses keep high scores even when they no longer answer the question, whereas short ones do not, demonstrating that AI judges reward verbosity largely independently of content alignment. Finally, API-based and batch inference inflate stochasticity, underscoring the need for controlled deployment.

12.
arXiv (CS.LG) 2026-06-15

Utility-Constrained Policy Optimization

arXiv:2606.14029v1 Announce Type: new Abstract: Constrained MDPs (CMDPs) are a widely adopted framework for incorporating safety into RL agents; however, the framework does not support risk-sensitive constraints. This can be problematic: For example, CMDPs allow for optimal solutions that, in order to satisfy the risk-neutral constraints, mix infrequent catastrophic behaviors and frequent, overly conservative ones. Moreover, prior empirical results suggest that enforcing stricter, risk-sensitive constraints can improve performance even under risk-neutral evaluation. The natural framework to incorporate risk-sensitive constraints is utility-constrained MDPs (UCMDPs), but no practical solutions for this problem existed. In this work, we introduce a simple yet powerful methodology for UCMDPs and constrained RL. Besides allowing for risk-sensitive constraints, our framework does not require us to fix constraint limits in advance of training the agent, provided that a sensible range is known. This increases policy flexibility and, in practice, allows for adjustments to these limits at no extra training cost. Besides benefiting from the generality of the framework, our agent shows strong performance in practice, consistently matching or outperforming existing baselines in several Safety Gymnasium benchmark tasks.

13.
arXiv (CS.CV) 2026-06-16

An Empirical Analysis of Optimization Dynamics and Sparsity Boundaries in Large-Scale Pedestrian Attribute Recognition

Pedestrian Attribute Recognition (PAR) is critical for video surveillance, enabling forensic search and re-identification systems. Extreme class imbalance remains a fundamental obstacle when merging PETA and PA-100K into a 109,000-image composite corpus, where minority attributes have positive sample fractions below 1%. This causes standard BCE optimization to suppress rare traits, a phenomenon we term the majority negative class cheating trap. We present a systematic ablation of Multi-Label Focal Loss hyperparameters (alpha and gamma) on a ResNet-18 backbone. A calibrated configuration (alpha=0.50, gamma=2.0) achieves a Macro F1-score of 62.32%, matching BCE baseline while preserving superior hard-example mining and convergence dynamics. Our approach uses pure loss-function engineering with zero computational overhead for edge deployment. We identify the Sparsity Wall, a hard boundary where positive sample fractions below 0.1% make global loss reweighting ineffective, requiring instance-level intervention.

14.
arXiv (CS.CL) 2026-06-11

LifeSentence: Language models can encode human life course trajectories from longitudinal panel data

Forecasting human life outcomes is important to gain insights into how individuals attain long and healthy lives. Conventional statistical approaches yield limited accuracy, potentially due to discarding the sequential structure of the life course. Modern methods such as transformer architectures require large scale training data that most longitudinal panel studies lack. Here we introduce LifeSentence, a model for life-course reasoning that bridges large language models with longitudinal panel data. By representing each life event as a structured natural-language record and instruction-tuning a pretrained 24-billion-parameter language model across an 18-task evaluation taxonomy spanning prediction, robustness and reasoning, LifeSentence supplements panel data with distributional knowledge already encoded during pretraining. Trained on approximately 65,000 individuals from the German Socio-Economic Panel - roughly 45 times fewer than prior transformer-based approaches - LifeSentence outperforms classical and deep learning baselines across all task families, achieving a threefold improvement in joint event-and-timing prediction from best baselines and 91.2% Kendall's tau when reconstructing chronological order from timestamp-stripped event sets. Without explicit supervision, the model recovers documented patterns of social stratification, including the education premium, the gender wage gap and the motherhood penalty, from discrete event sequences alone. A natural-language interface further enables qualitatively new research queries, such as connecting an early-life history to a specified late-life endpoint, establishing LifeSentence as both a predictive tool and a probe for counterfactual exploration of human biographies.

15.
arXiv (CS.CV) 2026-06-12

Stereo Vision-Based Fall Prediction and Detection using Human Pose Estimation on the AMD Kria K26 SOM

Background and Objective: Falls among elderly people can cause serious injury and reduce quality of life. Timely prediction and detection are essential to prevent harm and support well-being. We propose a portable, low-power, battery-operated, vision-based fall prediction and detection system using HPE on an AMD Kria K26 System-on-Module (SOM). The objective is a non-intrusive, privacy-preserving system for real-time fall detection. Methods: The system uses an Intel RealSense D455 range-sensing camera connected to the K26 SOM by USB. It captures synchronized RGB and depth frames, 640 x 480 x 3 and 640 x 480 pixels, at 60 FPS. The SOM runs a three-stage pipeline with quantized YOLOX, Anchor-to-Joint (A2J), and fall-detection models. YOLOX identifies human bounding boxes from RGB frames, then discards the RGB frames to preserve privacy. A2J uses depth frames to estimate 15 joint keypoints per person. A CNN uses selected joint coordinates (x, y, z) to classify fall activity. YOLOX was trained on CrowdHuman; A2J on ITOP, MP-3DHP, UR Fall Detection, and a custom SDSU PSG dataset; and the CNN on UR Fall Detection and SDSU PSG. The design used a single-core DPU with a serial pipeline and a dual-core DPU running YOLOX and A2J with multiple threads. Results: Quantized accuracy was evaluated using IoU >= 50% for YOLOX, mAP with a 10-cm rule for A2J, and classification accuracy, (TP + TN)/(TP + TN + FP + FN), for the CNN. Accuracies were 74%, 84.13%, and 75.85%. Throughput improved from 2.5 FPS for the single-threaded pipeline to 4.5 FPS for the multi-threaded version. Conclusion: Results demonstrate the feasibility of privacy-preserving fall detection on an AMD Kria K26 edge device. On-device HPE and fall classification runs without cloud dependency, supporting elderly monitoring and assistive healthcare. Future work will improve model accuracy and speed.

16.
arXiv (math.PR) 2026-06-16

Uniform integrability of the distance to the nearest leaf in random trees

arXiv:2606.15339v1 Announce Type: new Abstract: We study the distance from the root to the nearest leaf, the analogous quantity for a uniformly chosen vertex, and its protection number, in size-conditioned simply generated trees. We prove a uniform exponential tail bound for each of these quantities, valid for arbitrary offspring distributions. As a consequence, these random variables are uniformly integrable of every order. This yields convergence of all moments to those of the corresponding local limit. The argument is probabilistic and unified across the three quantities.

17.
arXiv (CS.CL) 2026-06-19

Disentangling Linguistic Relatedness from Task Alignment in Cross-Lingual Transfer

We study cross-lingual transfer by fine-tuning seven large language models (4B–671B parameters) on Arabic and evaluating zero-shot reading comprehension on Semitic languages and non-Semitic controls. Across dense and Mixture-of-Experts architectures, we find no evidence of Semitic-specific transfer: models with weak baselines improve dramatically across all languages, while strong-baseline models show only marginal gains regardless of language family. A chain-of-thought ablation reinforces this finding – the same models that benefit most from fine-tuning benefit equally from inference-time reasoning, suggesting both mechanisms address task-format alignment rather than cross-lingual knowledge transfer.

18.
arXiv (CS.AI) 2026-06-24

Tractable Reasoning and Conjunctive Query Answering for Defeasible DL-Lite under Rational Closure

arXiv:2606.24279v1 Announce Type: new Abstract: In Description Logics (DLs), reasoning under Rational Closure (RC) is a well-known and widely accepted non-monotonic formalism to handle defeasible knowledge. In this paper, we study the application of RC to the core and horn variants of the DL-Lite family of lightweight description logics. We analyze both entitlement (instance checking) and Conjunctive Query (CQ) answering under RC. Our main contribution is providing a plug-in architecture that builds upon existing standard classical reasoners, establishing that reasoning and CQ answering under RC for DL-Lite can be done efficiently with minimal computational overhead.

19.
arXiv (CS.AI) 2026-06-18

A Knowledge Theory of Capital:The Value of Natural and Artificial Intelligence

arXiv:2606.18288v1 Announce Type: cross Abstract: This volume develops a knowledge theory of capital for economies in which productive capacity increasingly resides in software, data, models, routines, expertise, platforms, organizations, commons, and public epistemic infrastructure. Beginning from Adam Smith's theory of labour, stock, specialization, and market extent, it asks what changes when knowledge becomes stock-like, mobile across forms, scalable, governable, recombinable, and imperfectly visible in accounting. The book introduces knowledge-bearing stock as the central object and analyses how it is generated, converted into governable form, deployed, improved through feedback, enclosed or shared, measured, impaired, and used as input to future production. It distinguishes embodied, disembodied, institutionalized, commons, and public knowledge forms and develops concepts such as first conversion, cognitive enclosure, feedback capture, dark capital, and expected knowledge loss. The argument is conditional and testable: modern wealth depends not only on capital accumulation, but on how productive knowledge is governed.

20.
medRxiv (Medicine) 2026-06-24

Multifactorial tuberculosis severity score for people living with HIV based on the Rand Appropriateness Method

Background In people living with Human Immunodeficiency Virus (PLWH), tuberculosis (TB) is the leading cause of death and is often associated with substantial morbidity. Better identifying PLWH with severe forms of TB could help target early interventions to reduce mortality and severe morbidity. Existing TB severity assessment tools may be sub-optimal for assessing disease severity in PLWH, since they incompletely integrate key determinants of disease severity. We aimed to develop a consensus-based TB severity score tailored to PLWH. Methods We developed a multifactorial TB severity score (TBSS) for PLWH using a modified Delphi process with a multidisciplinary group of international TB experts as the second part of a RAND/UCLA Appropriateness Method, following a previously published systematic review. Results Eight of 15 invited experts (53%) participated in both Delphi rounds. Of 62 candidate factors, 15 reflecting TB-related characteristics, host-related characteristics as well as characteristics related to both TB and host were rated as having high appropriateness for inclusion in the final TBSS. The total score ranges from 0 (no severity) to 61 (highest severity). Conclusion This study represents a first step towards the development of a multidimensional TB severity assessment tool for PLWH. However, its clinical usefulness, feasibility, and added value compared with existing severity scores remain to be demonstrated through validation studies before routine implementation can be considered. Key words: tuberculosis, HIV, severity.

21.
arXiv (CS.CL) 2026-06-12

An End-to-End Hybrid Framework for Rumour Detection in Low-Resources Algerian Dialect

The rapid growth of social media has intensified the spread of rumours. This issue is more challenging in the Algerian context due to the informal and code-switched nature of dialectal content, the scarcity of annotated resources, and the limited effectiveness of standard Arabic NLP tools on dialect text. This paper presents an end-to-end rumour detection hybrid framework for Algerian dialect social media content. We build a domain-specific annotated dataset by combining real social media posts, synthetic data, and the FASSILA corpus, with automatic labeling based on a similarity-based annotation process. A transliteration pipeline is also introduced to generate parallel datasets in Arabic script and Arabizi. We evaluate multiple approaches, including classical machine learning, deep learning, transformers, and hybrid models. Experimental results show that a hybrid approach combining transformer embeddings with a classical classifier achieves the best performance, reaching an F1-score of 0.84. We also find that domain-specific pre-training is more important than model size, with social media-trained models outperforming larger models trained on formal Arabic corpora. These results demonstrate the feasibility of rumour detection in low-resource Algerian dialect settings.

22.
arXiv (CS.LG) 2026-06-19

Optimal Coarse Correlated Equilibria in Mean Field Games: Linear Programming and No-Regret Learning

arXiv:2606.20062v1 Announce Type: cross Abstract: We introduce optimal coarse correlated equilibria for continuous-time mean field games. A coarse correlated equilibrium is a randomized recommendation scheme from which no player can gain by ignoring the recommendation and switching to an alternative strategy. The problem is as follows: a moderator selects, among all mean-field coarse correlated equilibria, one that optimizes a prescribed performance criterion, which may differ from the representative player's objective. After formulating the problem, we develop a linear programming (LP) formulation, prove the existence of optimal LP coarse correlated equilibria, and relate the LP characterization to the original probabilistic setting. Building on this characterization, we design a no-regret primal-dual algorithm, based on an equivalent Lagrangian formulation of the external-regret constraint, for learning such equilibria. We provide explicit convergence rates for the learning algorithm, and numerical examples illustrate the method.

23.
arXiv (CS.CV) 2026-06-19

PCFootprint: A Large-Scale Dataset and Benchmark for Vectorized Building Footprint Extraction from Aerial LiDAR Point Clouds

Building footprint extraction is a fundamental task in photogrammetry, remote sensing, and computer vision. Recent image-based methods have achieved remarkable progress in extracting vectorized footprints from high-resolution optical imagery. However, optical imagery inherently susceptible to occlusions, perspective distortions, and residual relief displacement, yielding incomplete or misaligned footprint extraction. Furthermore, the lack of explicit elevation information limits its direct applicability to Level of Detail building modeling. In this paper, we present PCFootprint, the first large-scale public dataset for footprint extraction from airborne laser scanning point clouds. PCFootprint comprises \num{33000} tiles derived from the Estonian Land and Spatial Development Board, covering diverse urban and rural landscapes. Each tile spans \qtyproduct{128 x 128}{\m} with systematically aligned vectorized footprints aligned to point clouds. The dataset includes a \num{3000} tiles cross-domain test set for evaluating generalization across geographic regions. We establish comprehensive benchmarks by evaluating mainstream methods. Experimental results reveal significant challenges including high intra-class variance, data imbalance, and noise across complex geospatial environments. We believe PCFootprint will advance future research in building modeling, urban scene understanding, and geospatial analysis. The PCFootprint dataset is publicly available at \url{https://huggingface.co/datasets/Haoyuan-Shen/PCFootprint}.

24.
Nature Medicine 2026-06-08

Post-adjuvant chemotherapy in ctDNA-positive patients with resected colorectal cancer: a randomized phase 3 trial

Authors:

Tumor-informed circulating tumor DNA (ctDNA) enables detection of molecular residual disease (MRD) after curative resection of colorectal cancer (CRC), but whether early intervention improves outcomes remains uncertain. ALTAIR was a randomized, double-blind, phase 3 trial embedded in the CIRCULATE-Japan platform evaluating a post-adjuvant ctDNA surveillance strategy with treatment initiation upon molecular recurrence. Patients with resected stage 0–IV CRC who became ctDNA positive after completion of standard-of-care therapy and had no radiological evidence of disease were randomly assigned (1:1) to receive trifluridine/tipiracil (FTD/TPI) or placebo for 6 months. The primary endpoint was investigator-assessed disease-free survival (DFS). Between July 2020 and June 2023, 243 patients were randomized to FTD/TPI (n = 122) or placebo (n = 121). Median DFS was 9.30 months with FTD/TPI and 5.55 months with placebo (hazard ratio = 0.79, 95% confidence interval: 0.60–1.05, P = 0.107), and the primary endpoint was not met. FTD/TPI increased grade 3 or higher hematologic adverse events (73.0% versus 3.3%) without new safety signals. These findings indicate that post-adjuvant intervention with FTD/TPI did not significantly improve DFS in ctDNA-positive patients without radiological disease. ClinicalTrials.gov identifier: NCT04457297 . In the randomized, double-blind phase 3 ALTAIR trial, patients with resected colorectal cancer who became positive for circulating tumor DNA during post-adjuvant surveillance received trifluridine/tipiracil hydrochloride therapy, which did not significantly prolong disease-free survival compared with placebo.