[Joy]

Hi all, I got my labs back from last week, the day I started Navelbine/herceptin. I wasn't expecting much since we knew the liver tumors were growing and we hadn't checked blood in 3 weeks and we were just starting treatment. I was bummed out though because my CA 27.29 jumped a bunch (which I expected) and my ALT and AST are now at 150 and 155 (not sure which is which) these are up by almost 100 points-totally freaks me out because they just haven't done that throughout the last 3 years despite chemo, more chemo, hormonals, etc. AND to top it all off I had that Circulating Tumor Cell test and, what a surprise. I have more ctc's than they like to see (6/7.5ml-should be 5 or below). All of my reading says that a value>5 means time to progression is faster and overall survival is STINKY. So, now I feel like I'm a goner and I'm all jacked up about it. This just came across my e-mail today.

Circulating Tumor Cells at Each Follow-up Time Point during Therapy of Metastatic Breast Cancer Patients Predict Progression-Free and Overall Survival

Daniel F. Hayes1, Massimo Cristofanilli2, G. Thomas Budd3, Matthew J. Ellis4, Alison Stopeck5, M. Craig Miller6, Jeri Matera6, W. Jeffrey Allard6, Gerald V. Doyle6 and Leon W.W.M. Terstappen6


Authors' Affiliations: 1 Department of Internal Medicine and the Comprehensive Cancer Center, University of Michigan Health and Hospital System, Ann Arbor, Michigan; 2 Department of Breast Medical Oncology, M.D. Anderson Cancer Center, Houston, Texas; 3 Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; 4 Department of Medicine, Washington University, St. Louis, Missouri; 5 Department of Medicine, Arizona Cancer Center, Tucson, Arizona; and 6 Immunicon Corp., Huntingdon Valley, Pennsylvania

Requests for reprints: Daniel F. Hayes, University of Michigan, 6312 CCGC, 1500 East Medical Center Drive, Ann Arbor, MI 48109. Phone: 734-615-6725; Fax: 734-615-3947; E-mail: hayesdf@umich.edu .

Purpose: We reported previously that 5 circulating tumor cells (CTC) in 7.5 mL blood at baseline and at first follow-up in 177 patients with metastatic breast cancer (MBC) were associated with poor clinical outcome. In this study, additional follow-up data and CTC levels at subsequent follow-up visits were evaluated.

Experimental Design: CTCs were enumerated in 177 MBC patients before the initiation of a new course of therapy (baseline) and 3 to 5, 6 to 8, 9 to 14, and 15 to 20 weeks after the initiation of therapy. Progression-free survival (PFS) and overall survival (OS) times were calculated from the dates of each follow-up blood draw. Kaplan-Meier plots and survival analyses were done using a threshold of 5 CTCs/7.5 mL at each blood draw.

Results: Median PFS times for patients with <5 CTC from each of the five blood draw time points were 7.0, 6.1, 5.6, 7.0, and 6.0 months, respectively. For patients with 5 CTC, median PFS from these same time points was significantly shorter: 2.7, 1.3, 1.4, 3.0, and 3.6 months, respectively. Median OS for patients with <5 CTC from the five blood draw time points was all >18.5 months. For patients with 5 CTC, median OS from these same time points was significantly shorter: 10.9, 6.3, 6.3, 6.6, and 6.7 months, respectively. Median PFS and OS times at baseline and up to 9 to 14 weeks after the initiation of therapy were statistically significantly different. Conclusions: Detection of elevated CTCs at any time during therapy is an accurate indication of subsequent rapid disease progression and mortality for MBC patients.