Originally published as JCO Early Release 10.1200/JCO.2008.20.6664 on September 14 2009

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Circulating Tumor Cells: A Useful Predictor of Treatment Efficacy in Metastatic Breast Cancer

From the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Northern Virginia Medical Oncology and Hematology Associates, Fairfax, VA; and Harry and Jeanette Weinberg Cancer Institute, Franklin Square Hospital Center, Baltimore, MD.

Corresponding author: Minetta C. Liu, MD, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007-2198; e-mail: liumc{at}georgetown.edu.

Purpose Five or more circulating tumor cells (CTCs) per 7.5 mL of blood predicts for poorer progression-free survival (PFS) in patients with metastatic breast cancer (MBC). We conducted a prospective study to demonstrate that CTC results correlate strongly with radiographic disease progression at the time of and in advance of imaging.

Patients and Methods Serial CTC levels were obtained in patients starting a new treatment regimen for progressive, radiographically measurable MBC. Peripheral blood was collected for CTC enumeration at baseline and at 3- to 4-week intervals. Clinical outcomes were based on radiographic studies performed in 9- to 12-week intervals.

Results Sixty-eight patients were evaluable for the CTC-imaging correlations, and 74 patients were evaluable for the PFS analysis. Median follow-up was 13.3 months. A statistically significant correlation was demonstrated between CTC levels and radiographic disease progression in patients receiving chemotherapy or endocrine therapy. This correlation applied to CTC results obtained at the time of imaging (odds ratio [OR], 6.3), 3 to 5 weeks before imaging (OR, 3.1), and 7 to 9 weeks before imaging (OR, 4.9). Results from analyses stratified by type of therapy remained statistically significant. Shorter PFS was observed for patients with five or more CTCs at 3 to 5 weeks and at 7 to 9 weeks after the start of treatment.

Conclusion We provide, to our knowledge, the first evidence of a strong correlation between CTC results and radiographic disease progression in patients receiving chemotherapy or endocrine therapy for MBC. These findings support the role of CTC enumeration as an adjunct to standard methods of monitoring disease status in MBC.

Supported by Veridex, Raritan, NJ.

Presented in part at the 44th Annual Meeting of the American Society of Clinical Oncology, May 30-June 3, 2008, Chicago, IL.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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