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Medline ® Abstract for Reference 73

of 'Systemic treatment for metastatic breast cancer: General principles'

73
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Circulating tumor cells versus imaging--predicting overall survival in metastatic breast cancer.
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Budd GT, Cristofanilli M, Ellis MJ, Stopeck A, Borden E, Miller MC, Matera J, Repollet M, Doyle GV, Terstappen LW, Hayes DF
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Clin Cancer Res. 2006;12(21):6403.
 
PURPOSE: The presence of>or=5 circulating tumor cells (CTC) in 7.5 mL blood from patients with measurable metastatic breast cancer before and/or after initiation of therapy is associated with shorter progression-free and overall survival. In this report, we compared the use of CTCs to radiology for prediction of overall survival.
EXPERIMENTAL DESIGN: One hundred thirty-eight metastatic breast cancer patients had imaging studies done before and a median of 10 weeks after the initiation of therapy. All scans were centrally reviewed by two independent radiologists using WHO criteria to determine radiologic response. CTC counts were determined approximately 4 weeks after initiation of therapy. Specimens were analyzed at one of seven laboratories and reviewed by a central laboratory.
RESULTS: Interreader variability for radiologic responses and CTC counts were 15.2% and 0.7%, respectively. The median overall survival of 13 (9%) patients with radiologic nonprogression and>or=5 CTCs was significantly shorter than that of the 83 (60%) patients with radiologic nonprogression and<5 CTCs (15.3 versus 26.9 months; P=0.0389). The median overall survival of the 20 (14%) patients with radiologic progression and<5 CTCs was significantly longer than the 22 (16%) patients with>or=5 CTCs that showed progression by radiology (19.9 versus 6.4 months; P=0.0039).
CONCLUSIONS: Assessment of CTCs is an earlier, more reproducible indication of disease status than current imaging methods. CTCs may be a superior surrogate end point, as they are highly reproducible and correlate better with overall survival than do changes determined by traditional radiology.
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Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. buddg@ccf.org
PMID