Circulating Cell Recurrance test

Brenda S · 09-08-2010, 07:10 AM

I’ve heard of a test that predicts the likelihood of recurrence of breast cancer. I think it is called the “circulating cell” test. Does anyone have any knowledge or information on this? Who is candidate for this test? What is it as accuracy? Any help is appreciated.
Thanks,
Brenda

Sheila · 09-08-2010, 07:15 AM

Is this the test you are asking about by Quest Diagnostics?

CellSearchTM' Circulating Tumor Cells, Breast Cancer

Test Summary

Clinical Use
•Predict progression-free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer
Clinical Background
Circulating tumor cells (CTCs) are extremely rare in healthy individuals and patients with nonmalignant diseases but are present in patients with various metastatic carcinomas with a wide range of frequencies.1-2 Some clinical studies indicate the assessment of CTCs can assist physicians in monitoring and predicting cancer progression and in evaluating response to therapy in patients with metastatic cancer.3-5
In patients with metastatic breast cancer, the number of CTCs has been shown to be a significant predictor of progression-free survival (PFS) and overall survival (OS).6,7 In a study by Cristofanilli et al,7 patients undergoing treatment for metastatic breast cancer with >5 CTCs/7.5 mL whole blood had shorter median PFS (2.7 months vs 7.0 months, P<0.001) and shorter OS (10.1 months vs >18 months, P<0.001) than patients having <5 CTCs/7.5 mL blood. In the same study, a decrease in the number of CTCs to <5 from baseline to first follow-up (4-5 weeks after initiation of new therapy) was also found to be predictive of PFS and OS. These results suggest the number of CTCs is a useful prognostic guide for patients with metastatic breast cancer and can reliably estimate disease progression and survival earlier (4-5 weeks vs 8-12 weeks, respectively) than traditional imaging methods.
Individuals Suitable for Testing
Patients with metastatic breast cancer, prior to a new course of therapy and at follow-up.
Specimen Requirements
•10 mL room temperature whole blood collected in CellSave Preservative Tube™'; 7.5 mL minimum.•Ship promptly; specimen must be tested within 72 hours of collection. Provide sample collection date and time. Do not refrigerate.•Samples may be collected prior to therapy and at first follow-up visit (4-5 weeks after initiation of new therapy). Allow at least 7 days after administration of doxorubicin before sample collection.
Method
•Immunomagnetic sample enrichment using antibodies targeting epithelial cell adhesion molecule (EpCAM) and cell labeling with fluorescent nucleic acid dye•Epithelial cells distinguished from leukocytes using fluorescent labeled monoclonal antibodies specific for leukocytes (CD-45) and epithelial cells (cytokeratins 8,18, and 19)•Results reported as number of CTCs/7.5 mL of whole blood•Analytical sensitivity: 1 CTC/7.5 mL whole blood•Analytical specificity: 99.7%2•Aliases: Breast Cancer CellSearch

Brenda S · 09-08-2010, 07:24 AM

Sheila,
Thanks for the reply. This article suggests it is only for those who have metastasis. Am I reading it correctly?
Brenda

Mary Anne in TX · 09-08-2010, 07:40 AM

Hi Brenda!
I had the test just because I wanted to. At the time, I just wanted to "feel" some knowledge of where I stood. (It was
part-way into having my granddaughter to rear) I think it was about $1200. and was well worth it to my "mental health"!
I got a 0 and celebrated for days! I do believe that it has been used more to see if treatment is working properly. It seems to give an answer more quickly than other methods.
I also did it incase I recur and need a baseline. Google it and you'll find lots of information. It is being used in other cancers also.
Best wishes, ma

Rich66 · 09-08-2010, 03:58 PM

It doesn't seem to be standard of care for adjuvant...at this point. But it might give you reason for extra vigilance if you had it and it gave a high number. My mom has full blown mets but has a reading of zero. No idea what it was before detection of recurrence. It's a little unclear at this point but it seems to go up when things are "worse".

Jackie07 · 09-08-2010, 03:58 PM

A recent research article discounted the importance of CTC in clinical settings:

Curr Opin Oncol. 2010 Aug 11. [Epub ahead of print]
Circulating tumor cells and emerging blood biomarkers in breast cancer.

Criscitiello C, Sotiriou C, Ignatiadis M.
aMedical Oncology Department, Belgium bBreast Cancer Translational Research Laboratory, Jules Bordet Institute, 121 Boulevard de Waterloo, Brussels, Belgium.
Abstract

PURPOSE OF REVIEW: To critically review the latest findings concerning the role of circulating tumor cells (CTCs) and other blood biomarkers in breast cancer.
RECENT FINDINGS: CTCs are epithelial tumor cells detected in the peripheral blood of patients with solid tumors using mainly cytometric/antibody-based and molecular approaches. Most technologies for CTC detection, including the FDA-approved CellSearch, are only detecting epithelial cell adhesion molecule (EpCAM)-positive CTCs and may miss clinically relevant subpopulations of CTCs. The value of CTC detection by CellSearch in metastatic breast cancer (MBC) may depend on the clinical setting and regimen used. In a retrospective analysis of 516 patients with MBC, CTC detection did not predict clinical outcome in chemo-naïve women with HER2-positive MBC treated with anti-HER2 therapy, but had prognostic value in other breast cancer subtypes. Similarly, changes in CTCs during treatment did not predict outcome in 67 women treated with first-line bevacizumab/chemotherapy. CTC detection by CellSearch before or after adjuvant chemotherapy was associated with worse disease-free survival in 1489 patients with early breast cancer. Circulating nucleic acids, microRNAs and genomic rearrangements have been suggested as promising blood biomarkers.
SUMMARY: Currently, there is no role for CTCs in clinical practice. The clinical utility of CTCs and other blood biomarkers should be prospectively tested.

Cal-Gal · 09-08-2010, 05:44 PM

The Life Extension website ran an article explaining it very well in April of this year-the same month they featured it in the magazine.

Lori R · 09-09-2010, 05:41 AM

Brenda,
My experience with the CTC test is in alignment with earlier posts.

I am Stage IV and after a few requests to my Onc, she finally agreed to order the test. Her belief was that it wasn't proven and had concerns about insurance willingness to pay. (which is did without any hassles....but then I am stage IV)

I don't register on any of the standard tumor marker tests, so I was desperately seeking something to give me a clue as to the party going on inside my body. (ok you partiers, time to leave....I've called the police)

Unfortunately, we started late as I took the test after I was 1/2 way through my Abraxane treatment. I was thrilled when I received a score of 0, but wasn't quite sure that the test was actually measuring anything.

When I had another recurrance I immediately retested with a score of 1. I will have another test here in November to see if the Navelbine can drive the test score back to 0.

So...seems that with everything there is a little "art" to the picture. For now, I'll continue to use.

There appears to be some controversey regarding this test and it's effectiveness.

Hope this provides some insights if your Onc is reluctant.

SunDiego · 09-16-2010, 11:09 AM

Wife had initial dx at Stage IV with a single liver met. Did the CTC before first chemo treatment last month and score was a 0. Unsure how to interpret that given the metastasis.

Chelee · 09-16-2010, 01:28 PM

My onc does run a CA27.29 and it does seem to be a good indicator for me that I've recurred. But I've been asking my onc to run a CTC for 3 yrs now. She always told me this test isn't prime time yet. But I've stayed on her about it and she just agreeded to order it at my last appt. She said she doubted my insurance would ok it. But like Lori said...being stage IV I don't see why they would say no?

Obviously they really don't use the CTC here because while in my infusion chair the gal that schedules all my appts, tests, scans came out to me and asked what this test was? Said she had never heard of--or ordered this test before. She has been there along time & is good at what she does so this surprised me. So I feel like I'm going to be the 1st one to have a CTC if Blue Cross OK's it? Although I wish I would of had a baseline CTC so I had something to compare it too. But first we will see if I get the green light.

Chelee