The Distribution of Circulating Tumor Cells Is Different in Metastatic Lobular Compared to Ductal Carcinoma of the Breast-Long-Term Prognostic Significance.

Ulrik Narbe,Pär-Ola Bendahl,Kristina Aaltonen,Charlotte Levin Tykjær Jørgensen,Mårten Fernö,Lisa Rydén,Carina Forsare,Anna-Maria Larsson

doi:10.3390/cells9071718

Ulrik Narbe, Pär-Ola Bendahl + Show 6 more

Open Access

https://doi.org/10.3390/cells9071718

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Journal: Cells	Publication Date: Jul 17, 2020
Citations: 10	License type: CC BY 4.0

Affiliation: Lund University, Växjö Kommun, Skåne University Hospital

Abstract

Background: Invasive lobular carcinoma (ILC) has distinguishing features when compared to invasive ductal carcinoma of no special type (NST). In this study, we explored the distributional and prognostic characteristics of circulating tumor cells (CTCs) in metastatic ILC and NST. Materials and methods: Patients were included in an observational trial (ClinicalTrials.gov NCT01322893) with ILC (n = 28) and NST (n = 111). CTC count (number/7.5 mL blood) was evaluated with serial sampling (CellSearch). The primary endpoint was progression-free survival (PFS). Results: The CTC counts were higher in ILC (median 70) than in NST cases (median 2) at baseline (p < 0.001). The evidence for ≥5 CTCs as a prognostic factor for PFS in ILC was weak, but stronger with higher cut-offs (CTC ≥ 20: hazard ratio (HR) 3.0, p = 0.01) (CTC ≥ 80: HR 3.6, p = 0.004). In NST, however, the prognostic effect of CTCs ≥5 was strong. Decline in CTC count from baseline to three months was associated with improved prognosis in ILC and NST. Conclusions: The number of CTCs is higher in ILC than in NST, implying that a higher CTC cut-off could be considered for ILC when applying the CellSearch technique.

Highlights

Breast cancer (BC) is the most common of all malignancies in women
We aimed to explore the distribution and prognostic significance of circulating tumor cells (CTCs) count and CTC clusters in patients with metastatic invasive lobular carcinoma (ILC) vs. no special type (NST) in a prospective monitoring trial exclusively including patients scheduled for first-line systemic therapy subject to longitudinal CTC sampling during six months with available long-term survival data
The progression and mortality rates for patients with ILC compared to NST were similar over the whole FU period

Summary

Introduction

World Health Organization, 2.1 million new cases were diagnosed worldwide in 2018. 20%–30% of all BCs at some point present as metastatic breast cancer (MBC) with dissemination to distant organs. Modern BC care has considerably progressed, but unmet needs still remain, especially for MBC. Invasive lobular carcinoma (ILC) has distinguishing features when compared to invasive ductal carcinoma of no special type (NST). We explored the distributional and prognostic characteristics of circulating tumor cells (CTCs) in metastatic ILC and NST. Materials and methods: Patients were included in an observational trial (ClinicalTrials.gov NCT01322893) with ILC (n = 28) and NST (n = 111). Results: The CTC counts were higher in ILC (median 70) than in NST cases (median 2) at baseline (p < 0.001).

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