Abstract
A determination of circulating tumor cell (CTC) effectiveness for prediction of progression-free survival (PFS) and overall survival (OS) was conducted as an adjunct to standard treatment of care in breast cancer management. Between November 2008 and March 2009, 22 metastatic and 12 early stage breast carcinoma patients, admitted to Ankara Oncology Training and Research Hospital, were included in this prospective trial. Patients' characteristics, treatment schedules and survival data were evaluated. CTC was detected twice by CellSearch method before and 9-12 weeks after the initiation of chemotherapy. A cut-off value equal or greater than 5 cells per 7.5 ml blood sample was considered positive. All patients were female. Median ages were 48.0 (range: 29-65) and 52.5 (range: 35-66) in early stage and metastatic subgroups, respectively. CTC was positive in 3 (13.6%) patients before chemotherapy and 6 (27.3%) patients during chemotherapy in the metastatic subgroup whereas positive in only one patient in the early stage subgroup before and during chemotherapy. The median follow-up was 22.0 (range: 21-23) and 19.0 (range: 5-23) months in the early stage and metastatic groups, respectively. In the metastatic group, both median PFS and OS were significantly shorter in any time CTC positive patients compared to CTC negative patients (PFS: 4.0 vs 14.0 months, Log-Rank p=0.013; and OS: 8.0 months vs. 20.5 months, Log-Rank p<0.001). OS was affected from multiple visceral metastatic sites (p=0.055) and higher grade (p=0.044) besides CTC positivity (log rank p<0.001). Radiological response of chemotherapy was also correlated with better survival (p<0.001). As a result, CTC positivity was confirmed as a prospective marker even in a small patient population, in this single center study. Measurement of CTC by CellSearch method in metastatic breast carcinoma cases may allow indications of early risk of relapse or death with even as few as two measurements during a chemotherapy program, but this finding should be confirmed with prospective trials in larger study populations.
Highlights
Breast cancer is the second most common cause of cancer death in women after lung cancer in United States (Siegel et al, 2013)
Metastatic and 12 early stage breast carcinoma patients, Absent admitted to Ankara.Oncology Training and Research Metastastic Site (s)
The incidence of circulating tumor cell (CTC) in breast cancer was reported to be 12-50% in early setting and 25-80% in advanced and metastatic settings depending on the methods used in different clinical studies (Riethdorf S et al.,2008; Franken et al.,2012)
Summary
Breast cancer is the second most common cause of cancer death in women after lung cancer in United States (Siegel et al, 2013). Metastatic breast cancer (MBC) is currently considered as an incurable disease but significant improvement in prognosis has been observed over the last decades (Siegel et al, 2013). Detection of Circulating Tumor Cells (CTC) was reported to be as an important prognostic marker from the results of 3 prospective randomised multicenter studies in breast, colon and prostate cancer (Cristofanilli et al, 2004; Cohen et al, 2008; De Bono et al, 2008). Importance of the early detection of treatment failure and early switching to the therapy before conventional clinical and radiological response evaluation has not been known, yet. Strategy of changing therapy versus maintaining therapy for metastatic breast cancer patients who have elevated circulating tumor cell levels after early treatment before classical radiological assessment were under study in a randomised prospective ongoing trials of Southwest Oncology Group (SWOG0500) and CirCe01 (France) trials (Bidard et al, 2012). Other ongoing trials STIC CTC METABREAST (France) and Endocrine Therapy
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