Circulating tumor cells predict survival of breast cancer

[Lani]

...and Dr. Daniel Hayes of the University of Michigan believes they can be used to indicate progression of metastatic breast cancer. He is starting a trial to test after the first dose of each new treatment for metastatic breast cancer whether or not it is working by following the change of these CBC. IT is a test already available from Quest and is called CELLSEARCH, I believe and requires special tubes which must be ordered ahead and sent to the facility. Since QUEST is a nationwide lab (they only process this test at one facility in Southern California when I last checked it out, sending the samples there) this should become available to everyone.

In the past it has not been felt to be somethiing to follow after initial treatment to look for progression, but I just found an article in the last two days which on first glance seemed to contradict that. Will look for the article and post it if applicable...

Circulating Tumor Cells Predict Survival in Metastatic Breast Cancer



By Will Boggs, MD

NEW YORK (Reuters Health) Aug 11 - The number of circulating tumor cells in women with metastatic breast cancer predicts progression-free and overall survival, according to a report in the July 15th issue of Clinical Cancer Research.

"Circulating tumor cells may be more specific than classic history, physical, radiograph, or serologic indications of progression," Dr. Daniel F. Hayes from University of Michigan Health and Hospital System, Ann Arbor, told Reuters Health.

Dr. Hayes and colleagues previously reported this association for women about to undergo new systemic therapy. In this study, they examined the predictive importance of continued monitoring of circulating tumor cells levels at subsequent time points in women with metastatic breast cancer.

The progression-free survival of women with fewer than five circulating tumor cells (range, 5.6 to 7 months) was significantly longer than the progression-free survival of women with 5 or more circulating tumor cells (range, 1.3 to 6 months), the authors report.

Women with 5 or more circulating tumor cells had a much higher likelihood of rapid death at all time points, the results indicate, and the overall survival was substantially longer for women with low circulating tumor cells counts (18.6 to more than 25.0 months) than for women with circulating tumor cells counts (6.3 to 10.9 months).

Patients with elevated circulating tumor cells counts at all time points had the shortest median progression-free survival (1.8 months), the researchers note, and women whose circulating tumor cells counts remained below 5 at all time points had the longest median progression-free survival (7.2 months). The results were similar for median overall survival.

"The results from the current analysis suggest that elevated circulating tumor cells levels at any time in the clinical course of a patient with metastatic breast cancer are harbingers of impending progression," the authors conclude.

"We are about to open a prospective, randomized clinical trial in which patients starting a new first-line chemotherapy will be checked at first follow-up," Dr. Hayes told Reuters Health.

"If they still have elevated circulating tumor cells (suggesting that the current therapy is unlikely to work)," the patients will be randomized to stay on that therapy until signs of progression or to immediately be changed to a new chemotherapy, Dr. Hayes said. "This study will be led by the Southwest Oncology Group in association with the North American Breast Cancer Intergroup."

Clin Cancer Res 2006;12:4218-4224.



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