leo
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Joined: 23 Sep 2004
Posts: 1574
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 Posted: Sat Apr 09, 2005 3:40 pm Post subject: CellSearch for circulating tumor cells in breast cancer |
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Dear Users,
I just read an article about a test known as CellSearch, which measures circulating tumor cells in the blood. It seems when more than 5 circulating tumor cells (CTCs) in 7.5ml of blood, the prognosis is not good. Whether this should be standard of care and if therapy should be changed after high levels of CTCs are detected are not well-defined.
Just to let you know that this option is out there, and that in my view it may eventually be incorporated into the follow-up routine of breast cancer patients...
regards,
Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice. |
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Roxi1
Experienced user
Joined: 26 Dec 2004
Posts: 54
Location: Nevada
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| Posted: Sat Apr 09, 2005 11:17 pm Post subject: Re: CellSearch for circulating tumor cells in breast cancer |
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wow, that is very interesting. Do you have the references on this article that you can submit to us?
Roxanne
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Roxanne
Lumpectomy R. Breast 1/5/05, Post-Menopausal
1.2 cm invasive ductal CA
Histology Grade 2
Estrogen/Progesterone +
Her-2/neu Negative
Nodes negative, 2 Sentinel, 8 other nodes
RT 28+5, Tamoxifen (as osteoporosis) |
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leo
Owner
Joined: 23 Sep 2004
Posts: 1574
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| Posted: Sun Apr 10, 2005 12:20 pm Post subject: cellsearch |
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Hello
There is no data about when it is useful. All we know comes from the studies that were done early after treatment. Still, this can be used at any point, even several years after. The problem is what to do with the information gathered, since to date there is no proof that this test can help guide treatment.
regards,
Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice. |
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TFrancis
New User
Joined: 15 Dec 2005
Posts: 2
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| Posted: Mon May 15, 2006 12:55 pm Post subject: CellSearch for circulating tumor cells in breast cancer |
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I am familiar with the CellSearch research, the Aug 2004 New England Journal of Medicine article that outlines what the CellSearch results mean and how doctors and patients are using their CTCs (Circulating Tumor Cells) results to guide treatment.
I have been helping two patients use CellSearch with their doctors at Hershey Medical, University Pittsburgh Medical Center, and Mt. Nittany Medical Center, State College, PA.
If you need a copy of the NEJM article, please feel free to contact me via E-mail at: dechaumontquitry@gmail.com Sincerely, Theodore Francis
Circulating Tumor Cells, Disease Progression, and Survival in Metastatic Breast Cancer, Authors: Massimo Cristofanilli, Thomas Budd, Matthew J Ellis, Alison Stopeck, et al. The New England Journal of Medicine. Boston: Aug 19, 2004.Vol. 351, Iss. 8; pg. 781, 11 pgs
ABSTRACT
BACKGROUND
We tested the hypothesis that the level of circulating tumor cells can predict survival in metastatic breast cancer.
METHODS
In a prospective, multicenter study, we tested 177 patients with measurable metastatic breast cancer for levels of circulating tumor cells both before the patients were to start a new line of treatment and at the first follow-up visit. The progression of the disease or the response to treatment was determined with the use of standard imaging studies at the participating centers.
RESULTS
Outcomes were assessed according to levels of circulating tumor cells at baseline, before the patients started a new treatment for metastatic disease. Patients in a training set with levels of circulating tumor cells equal to or higher than 5 per 7.5 ml of whole blood, as compared with the group with fewer than 5 circulating tumor cells per 7.5 ml, had a shorter median progression-free survival (2.7 months vs. 7.0 months, P<0.001) and shorter overall survival (10.1 months vs. >18 months, P<0.001). At the first follow-up visit after the initiation of therapy, this difference between the groups persisted (progression-free survival, 2.1 months vs. 7.0 months; P<0.001; overall survival, 8.2 months vs. >18 months; P<0.001), and the reduced proportion of patients (from 49 percent to 30 percent) in the group with an unfavorable prognosis suggested that there was a benefit from therapy. The multivariate Cox proportional-hazards regression showed that, of all the variables in the statistical model, the levels of circulating tumor cells at baseline and at the first follow-up visit were the most significant predictors of progression-free and overall survival.
CONCLUSIONS
The number of circulating tumor cells before treatment is an independent predictor of progression-free survival and overall survival in patients with metastatic breast cancer.
DISCUSSION
The results of this trial indicate that in metastatic breast cancer the level of circulating tumor cells before a new therapy is initiated and, even more important, the level measured at the first follow-up visit are useful predictors of progression-free survival and overall survival. Circulating tumor-cell levels of > or =5 cells per 7.5 ml of blood - a cutoff point that was prospectively identified in patients in a training set and confirmed in patients in a validation set - gave a reliable estimate of disease progression and survival earlier than estimations made with the use of traditional imaging methods (3 to 4 weeks vs. 8 to 12 weeks after the initiation of therapy, respectively). In a multivariate analysis, the predictive value of the level of circulating tumor cells, either at baseline or at the first follow-up visit, was independent of the time to metastasis, the site of metastasis (visceral as compared with nonvisceral), and hormone-receptor status.25,26
Table 2 (above). Progression-free Survival and Overall Survival among Patients with Metastatic Breast Cancer According to the Levels of Circulating Tumor Cells (CTC).
Table 3 (above). Prediction of Progression-free Survival and Overall Survival.*
An unplanned subgroup analysis suggested that the predictive accuracy of the number of circulating tumor cells was not valid in all patient groups for all end points. The number of circulating tumor cells before hormonal treatment was started was not significantly associated with overall survival (P=0.09), although the number of circulating tumor cells after the initiation of therapy was significantly associated with overall survival (P=0.002).
The CellSearch and CellSpotter assay systems were designed to detect rare epithelial cells in whole blood. One can assume that in patients with metastatic breast cancer most of the cells identified as circulating tumor cells are malignant, because such cells were detected in only 1 percent of 345 control subjects, none of whom had >3 cells per 7.5 ml of blood. Furthermore, other investigators, using a similar assay, have reported that chromosomal abnormalities in circulating tumor cells obtained from patients with metastatic epithelial cancers matched those in the primary lesion,27 indicating that the circulating cells were derived from the tumor.
Personnel in the testing laboratories were aware that they were analyzing specimens obtained from control subjects and from patients with metastatic disease, but they were completely unaware of the results of clinical and radiographic assessments and the outcomes of the patients who were the main focus of this study. Although we found a difference between the number of detectable circulating epithelial cells in patients with metastatic breast cancer and the number in normal subjects and women with benign breast conditions, the results of our study do not support the use of this assay as a screening tool to detect a new primary cancer or metastatic breast cancer.
The prognostic implications of an elevated level of circulating tumor cells for patients with metastatic disease who are starting a new treatment represent an opportunity to stratify such patients in investigational studies. The very short median progression-free survival in patients with elevated levels of circulating tumor cells at the first follow-up visit suggests that these patients are receiving ineffective therapy. We stress that our results may not be valid for patients who do not have measurable disease or those starting a new regimen of hormone therapy, immunotherapy, or both. This study did not address whether patients with an elevated number of circulating tumor cells might benefit from other therapies. Whether such patients might benefit from other therapies is under investigation.
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dechaumontquitry@gmail.com
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dechaumontquitry@gmail.com |
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