HER2 Support Group Forums - View Single Post - if this holds up, method for following adjuvant treatment of breast cancer may change

Lani · 04-06-2010, 09:04 AM

After completing adjuvant treatment, most, naturally, hope for some way to tell if it was effective

There seems to be a lot of nihilism among oncologists that there really is nothing that can give that answer and probably never will be

I have previously suggested that serial bone marrow testing might give the answer, but oncologists seem to be averse to this suggestion (although when I ask them and discuss it with them at meetings, they finally admit that they never thought that patients might be more willing to undergo the procedure than they are willing to think about doing it, and realize they may be irrational about it)

In any case, they are desperately trying to get the same or similar information from circulating tumor cells and here is the latest:

ABSTRACT: Single circulating tumor cell detection and overall survival in nonmetastatic breast cancer
[Annals of Oncology; Subscribe; Sample]

Background: Circulation of cancer cells in the blood is a mandatory step for metastasis, but circulating tumor cells (CTC) have a low metastatic efficiency in preclinical animal models. In this prospective study, we reported the clinical outcome of nonmetastatic breast cancer patients according to CTC detection.

Patients and methods: In 115 nonmetastatic patients diagnosed with large operable or locally advanced breast cancer, we prospectively detected CTC using the CellSearch system before and after neoadjuvant chemotherapy in a phase II trial (REMAGUS02).

Results: At baseline, 23% of patients were CTC positive, but only 10% had >1 CTC/7.5 ml of blood. After a median follow-up of 36 months, CTC detection before chemotherapy was an independent prognostic factor for both distant metastasis-free survival [DMFS; P = 0.01, relative risk (RR) = 5.0, 95% confidence interval (CI) 1.4-17] and overall survival (OS; P = 0.007, RR = 9, 95% CI 1.8-45). CTC detection after chemotherapy was of less significance (P = 0.07 and 0.09, respectively). Moreover, CTC detection showed interesting characteristics as an individual predictive test for metastatic relapses (sensibility 55%, specificity 81%, and global accuracy 77%).

Conclusions: Detection of ≥1 CTC/7.5 ml before neoadjuvant chemotherapy can accurately predict OS. Our findings may change the clinical management of nonmetastatic breast cancer and indicate that the metastatic efficiency of CTC could be higher than previously reported.

04-06-2010, 09:04 AM	#1
Lani Senior Member Join Date: Mar 2006 Posts: 4,780	if this holds up, method for following adjuvant treatment of breast cancer may change After completing adjuvant treatment, most, naturally, hope for some way to tell if it was effective There seems to be a lot of nihilism among oncologists that there really is nothing that can give that answer and probably never will be I have previously suggested that serial bone marrow testing might give the answer, but oncologists seem to be averse to this suggestion (although when I ask them and discuss it with them at meetings, they finally admit that they never thought that patients might be more willing to undergo the procedure than they are willing to think about doing it, and realize they may be irrational about it) In any case, they are desperately trying to get the same or similar information from circulating tumor cells and here is the latest: ABSTRACT: Single circulating tumor cell detection and overall survival in nonmetastatic breast cancer [Annals of Oncology; Subscribe; Sample] Background: Circulation of cancer cells in the blood is a mandatory step for metastasis, but circulating tumor cells (CTC) have a low metastatic efficiency in preclinical animal models. In this prospective study, we reported the clinical outcome of nonmetastatic breast cancer patients according to CTC detection. Patients and methods: In 115 nonmetastatic patients diagnosed with large operable or locally advanced breast cancer, we prospectively detected CTC using the CellSearch system before and after neoadjuvant chemotherapy in a phase II trial (REMAGUS02). Results: At baseline, 23% of patients were CTC positive, but only 10% had >1 CTC/7.5 ml of blood. After a median follow-up of 36 months, CTC detection before chemotherapy was an independent prognostic factor for both distant metastasis-free survival [DMFS; P = 0.01, relative risk (RR) = 5.0, 95% confidence interval (CI) 1.4-17] and overall survival (OS; P = 0.007, RR = 9, 95% CI 1.8-45). CTC detection after chemotherapy was of less significance (P = 0.07 and 0.09, respectively). Moreover, CTC detection showed interesting characteristics as an individual predictive test for metastatic relapses (sensibility 55%, specificity 81%, and global accuracy 77%). Conclusions: Detection of ≥1 CTC/7.5 ml before neoadjuvant chemotherapy can accurately predict OS. Our findings may change the clinical management of nonmetastatic breast cancer and indicate that the metastatic efficiency of CTC could be higher than previously reported.