tying decreasing CTC #s 2 PROGNOSIS, improvement with treatment of her2+ BRAIN METS

[Lani]

ABSTRACT: Circulating tumor cells and brain metastasis outcome in patients with HER2-positive breast cancer: the LANDSCAPE trial
[Annals of Oncology]
Background: Decrease of circulating tumor cells (CTC) during treatment is an independent prognostic factor in metastatic breast cancer (MBC). We specifically evaluated the impact of CTC on brain metastasis outcome.

Methods: HER2-positive MBC with brain metastasis not previously treated with whole-brain radiotherapy received first-line combination of lapatinib and capecitabine in a phase II study. CTC were detected at baseline and day 21 (CellSearch).

Results: Median follow-up of the 44 analyzed patients was 21.2 months. The central nervous system objective response (CNS-OR) rate was 66%. At baseline, 20 of 41 assessable patients for CTC (49%) had ≥1 CTC (range 1-301, median 3) and 9 (22%) had ≥5 CTC. At day 21, 7 of 38 patients (18%) had ≥1 CTC (P = 0.006, versus baseline), and CTC had disappeared in 11 patients. CNS-OR rate was significantly higher in patients with no CTC at day 21 [25 of 31 (80%) versus 2 of 7 (29%), P = 0.01]. The 1-year overall survival rate was 83.9% in patients with no CTC at day 21 versus 42.9% in patients with ≥1 CTC (P = 0.02).

Conclusions: This is the first report showing a correlation between CNS metastasis response, outcome and early CTC clearance under targeted treatment of HER2+ MBC.

[Rolepaul]

CTC were seen in the spinal fluid with Nina from January through May 2012. She has had one report of CTC's in October of 2012 and none seen since then. We track CNS protein and glucose with each four week treatment as well. These have been good indicators for others with HER+ CNS involvement, as well non-HER+ CNS involvement. There has been no white or red blood cells in the CNS for 15 months, indicative that the BBB has probably recovered from the METs to the brain.
I am not a doctor or Clinical Trial person, but I can tell you I am a lot better informed after four years of fighting this garbage, and two years after being told Nina should make end of life decisions. We have celebrated a lot of events, but it has cost $60,000 after insurance.
Paul