Here it is: Circulating tumor cells associated with bad px in EARLY breast cancer

[Lani]

previous articles were only with metastatic breast cancer

Will have to see if the CELLSEARCH test I referred to in my previous post is the same technology as used in this article to find CTCs

This certain seems like an improvement to--wait until you have bone pain from fracture or a headache before we look to see if it is coming/has come back!


10 August 2006
Circulating tumor cells predict poor node-negative prognosis
Circulating tumor cells (CTCs) may be used to identify patients with node-negative (N0) breast cancer who are at high risk of a poor outcome, say Greek researchers who believe the prognostic factor could be used to guide treatment decisions.

Previously, they showed that the presence of peripheral blood CTCs positive for cytokeratin (CK)-19 mRNA is an independent prognostic factor for recurrent disease and poor survival in patients with stage I and II operable breast cancer.

To investigate further, the team used a real-time polymerase chain reaction assay to assess for CK-19 mRNA-positive cells in blood samples from 167 N0 breast cancer patients who had undergone surgery but were chemotherapy-naïve. The participants were followed-up for a median of 32 months, during which time they received a range of adjuvant systemic therapies.

In all, 21.6% of patients were positive for the CTCs, Vassilis Georgoulias (University General Hospital of Heraklion, Crete) and colleagues report.

Interestingly, the researchers found that patients with CTCs were significantly more likely to be positive for human epidermal growth factor 2 (HER2/neu) expression than those without the cells (36.1% vs 19.1%).

No significant correlation was detected between CK-19 mRNA-positive cells and other patient or tumor characteristics such as age, menopausal status, histology, size, and hormone receptor status.

However, multivariate analysis indicated that CK-19 mRNA-positivity predicted both early clinical relapse and breast cancer-related mortality in the women.

In particular, CTCs predicted reduced disease-free survival (hazard ratio [HR]=26.32), along with estrogen receptor-negative status (HR=5.54), grade III disease (HR=3.79), and premenopausal status (HR=4.64). Overall survival was predicted by CK19 mRNA-positivity alone, with a HR of 17.94.

Writing in the Journal of Clinical Oncology, the team says that the development of techniques to measure disseminated tumor cells in blood rather than bone marrow "opens the way to further investigate important questions such as whether the detection of CTCs should be performed in all patients at the time of primary diagnosis to identify high-risk patients, or whether CTCs detection at diagnosis should modify the adjuvant therapeutic strategy, or finally, whether the detection of CTCs during the administration of adjuvant treatment would allow the development of secondary adjuvant theapeutic strategies."

The authors conclude: "The study and evaluation of the clinical relevance of CTCs opens the possibility of early and tailored treatment interventions for patients with persisting occult tumor cells after systemic adjuvant treatment."



J Clin Oncol 2006; 24: 3756–3762

http://www.jco.org/cgi/content/abstract/24/23/3756

[kim]

great-
my dr did a cell search on me after I completed chemo and 1 year of herceptin that showed CTC, I was stage 2. He kept me on herceptin and all follow up tests have been zero, however now I feel like I have been handed a death sentence. I am so tired of this disease.
Kim
Sorry, I hope it does not sound like I am shooting the messenger, I am just feeling a bit down.

[R.B.]

I grind on like an old record, but if you have not given it any thought do have a look at the omega three six posts.

There is a huge amount of reseach suggesting low levels of DHA may be linked to depression.

Also please see the posts on fructose ( purified as in sweetened used in drinks etc as against that in whole fruit which is OK ), which I have just started reading about as part of trying to get the vaugest understanding as to what influences fat metabolism oxidation and storage. An article I have just read descirbes it as a "modern epidemic...frightful consequences to the health of humans worldwide" and from the little I have read I do not beleive that this article, which appears to be written by women, is exagerating.

Here the link for it. A good way of keeping the mind occupied - I am still re re reading it tring to understand it!!!

http://www.pubmedcentral.gov/article...medid=15723702

Fructose, insulin resistance, and metabolic dyslipidemia
Heather Basciano,1 Lisa Federico,1 and Khosrow Adeli 1



From my own experience it takes the edge off the grey days, make colours a bit brighter etc.

I would send you a row of smileys but have no idea how to do it.

I hope the sun flowers butterflys and bees come back out soon.

RB

[Montana]

So, even though I finished treatment a year ago June, (just on Arimidex, no Herceptin), is this a test I could ask my onc to do? Would there be any purpose in knowing if I have CTC's?
I was only Stage I, no nodes.

[sassy]

Same question as Montana. Is this a test I could have done now? Was stage IIb or IIIa (two docs differed) and triple positive. Might this be a factor for continued herceptin?
________
CruelLady

[Lani]

But I don't think it can hurt to be tested and I don't think the test costs that much more than tumor markers. Why don't you bring it up with your oncologist --most will probably say "we don't have data to support that yet"

You can retort: does that mean for your wife/mother/sister/daughter you would not do anything that they do not yet have data to support?

There is so much more we don't know about this disease than what we know--we must always "push the envelope"

[Lani]

I would print out this article and the other I posted in the last 24 hours on CTCs indicating progression in metastatic breast cancer. They are both HOT OFF THE PRESS and if your oncologist is trying to decide whether to continue herceptin past one year perhaps he/she would test you to help make the decision. However if he/she is one of the "we don't have data to support that" types of oncologists--you will just have to keep reviewing the literature to see what new articles pop up supporting the use of CTCs in early breast cancer. If your oncologist acknowledges we don't know all the answers yet so it is reasonable to use our brains and follow common sense you might just convince them to get this test. Sorry to be so opinionated, but waiting for new positive research findings in TESTING (as opposed to TREATMENT where they must try to make sure something is safe) to come into clinical practice can be frustrating.

[kim]

My oncologist did this test on me as a stage 2. It was after I had completed chemo and a year of herceptin, this was in Dec 2004. Because it did show CTC he did keep me on herceptin. He repeats the test about every 6 mos and all subsequent test have showed no CTC.
Hope this helps,
Kim

[sassy]

Thank you for the information Lani. I appreciate all the work you do for all of us!
________
WEED VAPORIZER

[Cathya]

Lani;

I am wondering if testing for CLC's wouldn't be particularly helpful for borderline Her2+'s as it is thought that there are other pathways for us. I am thinking that the Serum Her2 test is good, the other tumor marker tests as well but perhaps this would be more all encompassing??? Perhaps I am off the mark here but am wondering what combination of markers should be used for triple positive borderlines.....like me....lol.

Thanks,

Cathy

[Lani]

I think either circulating tumor cells and/or bone marrow biopsies should be examined in all new her2+ diagnosed patients before they start herceptin and , say, 6 and 12 months after starting herceptin. Since noone knows how long herceptin should be given, since breast cancer appears to be a stem cell cancer (dormant , slowly dividing cells in bone marrow give rise to recurrences) and since chemo has been shown to only get rid of the quickly dividing cells and not the bone marrow dormant cells, I think it would be great way to evaluate the success of a course of treatment, rather than waiting for a bone to break or a seizure to occur or a patient to turn yellow. Should recurrence/progression be detected earlier, perhaps it would no longer be so massive that it overwhelms the treatment (too many cells have too many "tricks up their sleeves" to elude the pathways involved in the treatment type. )

Braun et all from Germany are starting a trial to see how these sequential bone marrows come out.

The crazy thing is., when asked why bone marrow are not done more often on breast cancer patients, oncologists answers that patients wouldn't put up with it because they don't like them, just as they say patients would rather take daily pills than a once a month shot for antihormonal therapy.
How can they talk about patients not liking bone marrow biopsies (the first of which can be done under anaesthesia of the operation) and the others under local anaesthesia, when they so freely treat them with chemotherapy agents which are I am sure much more noxious and unpleasant. Similarly, how can they decide for a patient that they don't like shots and prefer daily pills. I have heard this over and over again and I just don't get it!

[AlaskaAngel]

Admittedly it is too easy as a patient to be optimistic about how well this could work... but given that caveat... just think how many screening MRIs and CTs and PETs could be held off until the cell count or symptoms indicate they should be done...

So Lani, would you think this test reasonable for Stage 1 HER2's who haven't had Herceptin and who are so far as they know, NED?

(Especially if the sample can be sent in from places like where I live...)

Wishful thinking or thinking positive,

A.A.

[Lani]

This is the first report on CTCs being useful in early breast cancer from what I've seen.

The good news is Quest seems to be a nationwide company and send all their Cell Search samples to the same location in Southern California.

Perhaps you could price the test and see if your oncologist will go for it. He/she will probably say I will order it if it is likely to change your course of treatment. They would then probably say if it is elevated and work-up shows you have metastatic disease you are now in the incurable category and we will only do what will prolong your life but not cure you anyway.

This is the type of thinking I hope we can change by catching metastatic disease when it is so early with so few cells that not enough of them can "change their tune" to avoid the targetted therapies we will hopefully have against them.