Ctc?

[Rich66]

How many folks' oncs run the circulating tumor cell test?

[Mary Anne in TX]

I had one done, but had to ask for it. I don't know how many other of his patients have had one done. Ma

[Joan M]

Rich,

I was told by Sloan-Kettering that they do not believe that the CTC test is meaningful and therefore don't use it. Ditto, for New York Presbyterian Hospital/Weill Cornell Medical Center, also in NYC.

However, several women on this site have had a CTC test.

Joan

[bejuce]

I had one done at Stanford as part of a clinical trial.

[sassy]

My onc declined giving one.

[mmoons]

My onc said no...not reliable - yet.

[Lori R]

My onc was reluctant as she thought there would be insurance hassles.

I pushed for it and received a score of 1 at a time that I was dealing with a recurrance. Insurance paid the $600, so I felt very vindicated.

I pushed for it again and received another score of 1. This time insurance refused to pay and I had to argue with them for over a year. The insurance battle was very frustrating and emotionally exhausting.

I am reluctant to request another one unless I am willing to pay the $600 out of my pocket.

Since the standard tests do not work for me, I was grasping at some way to give me insights regarding disease progression.

If I recur, I might be willing to pay the $.

[pibikay]

CTC is news to us here

[gdpawel]

It would be important to develop a method of in vivo labelling of tumor cells in the circulation and to monitor their trafficking and homing to other sites. If these cells are viable and therefore able to disseminate, I think the most robust test to this end is to document their ability to metastasize.

There was a symposium in Washington DC in September of 2009, devoted entirely to the CTC technology. The cutoff is 5 tumor cells. Less than 5 means that things are going well. More than 5 means that things are going poorly. But you can see the difference between 4 and 6 is not all that great.

What they found out from that symposium was that it's perhaps useful as an adjunct to traditional methods for following tumor response, such as x-rays, blood tests, CTs, MRIs, history, physical exam, etc.

Some molecular tests do utilize living cells, but generally of individual cancer cells in suspension, sometimes derived from tumors and sometimes derived from circulating tumor cells. This was tried with the human clonogenic assay, which had been discredited long ago.

Again, traditionally, in-vitro (in lab) "cell-lines" have been studied in 2 dimensions (2D) which has inherent limitations in applicability to real life 3D in-vivo (in body) states.

[StephN]

The specific HER2 serum test is more widely used. I do get that a couple of times a year.

You might look up the Cell Search web site and see what they have to say, or if there is a patient liason phone line you could call.

[mamacze]

My oncologist just ordered the Veridex CellSearch Circulating Tumor Cell blood test. Quest offers the test. This is a nice plain English summary of the test:
http://www.oncbiz.com/interviews/pdf...AN09_OC_MC.pdf According to this article; Medicare also pays for it. I have just sent an insurance appeal to my local Connecticare insurance company to see if they will pay for it. I will keep you posted; re results..
Love Kim from CT

[Rich66]

Kim,
From what I've seen, the test might have the most utility for monitoring NED patients with long scan intervals.

[anna4969]

Hi Rich,

I asked my oncologist at MD Anderson for this test in May. She declined, with very much the same reasoning, unreliable. I still would like very much to have one, but now after this discussion, I would worry about being responsible for the $600 fee if insurance put up a fuss. Hope this info helps.

[Chelee]

I asked for a CTC for a few yrs and always got the same answer, "It's not prime time yet". But once I recurred and was stage IV I asked again...this time a bit more pushy about it. Plus I told my onc I'd be less likely to scan if both my CA27.29 & CTC came back the same...meaning both low, or both high.

My onc told me if my insurance will pay for it she will do it. Blue Cross did cover it, no doubt since I'm stage IV.

Chelee

[caya]

My onc. does not do it, same reason as most others - unreliable.

all the best
caya

[Lani]

GDPAWEL--I THINK THE INFO YOU RECEIVED AT THE 2009 MEETING IS DATED.

MANY PAPERS QUOTE ANY CTCS AS ABNORMAL, BUT OF COURSE IT DEPENDS ON THE TECHNOLOGY UTILIZED, WHICH IS EVOLVING

AT ASCO in June I frequented a booth of a company which is utilizing a non-magnetic technology to isolate the tumor cells and then phenotyping them (ER,PR, her2 status etc determined on the INDIVIDUAL cells) and said they would be available for the general public (and inferred FDA approved) within one month (that should be this upcoming week!)

Most papers correlate ctcs with treatment response and/or progression only in stage IVs, but some are using them to try to determine if adjuvant treatment in early stagers was efficacious.

Various platforms are being developed--besides the Veridex/J&J tehcnology based on magnetic beads with EpCam, there is the Adnar test (uses three antigens/markers), the Dana-Farber/Mass General technology, the Magnasweep technology developed by Stefanie Jeffrey at Stanford and this new technology--will try to unpack my long not-unpacked bag with handouts from ASCO and get the company name--among others.

Hope this helps!

[gdpawel]

Whatever will be more useful as an adjunct to traditional methods for following tumor response, such as x-rays, blood tests, CTs, MRIs, history, physical exam, etc. However, in regards to drug selection, analysis of a relatively small number of isolated cancer cells cannot yield the same quality information as subjecting living cells to chemotherapeutic agents, begging the question of whether or not it can accurately predict which drugs will work and which will not.

[Rich66]

I don't know..is that a way of suggesting they have no effective treatment for lung cancer?

But..it would seem no matter what information guides drug selection tools to monitor suggest when things are working or not. I wonder if CTCs won't turn out to be like other markers..helpful for some, useless for others.

[gdpawel]

You should know about those arcane clinical studies Rich. Someone just happen to do one with lung cancer instead of breast cancer, to prove a point. 11 radiographs, 6 CT scans, a PET scan, and MRI, two echocardiograms, and an ultrasound, all within two years of diagnosis? Boy! that could be expensive. Perhaps the CTC prognostic technique could save our health care system some money?

[Rich66]

Dunno..CTC might tell overall picture in some..especially if NED and needing some monitoring. But it won't tell specifics in someone with active disease..specifics like where the activity is...liver, lung, brain, bone etc. 1st two years in an average lung cancer patient might be very different scenario than most breast cancer patients.