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Clinical Cancer Research Vol. 12, 6403-6409, November 1, 2006
© 2006 American Association for Cancer Research


Imaging, Diagnosis, Prognosis

Circulating Tumor Cells versus Imaging—Predicting Overall Survival in Metastatic Breast Cancer

G. Thomas Budd1, Massimo Cristofanilli2, Mathew J. Ellis3, Allison Stopeck4, Ernest Borden1, M. Craig Miller5, Jeri Matera5, Madeline Repollet5, Gerald V. Doyle5, Leon W.M.M. Terstappen5 and Daniel F. Hayes6

Authors' Affiliations: 1 Cleveland Clinic Foundation, Cleveland, Ohio; 2 M.D. Anderson Cancer Center, Houston, Texas; 3 Washington University, St. Louis, Missouri; 4 University of Arizona, Tucson, Arizona; 5 Immunicon Corp., Huntingdon Valley, Pennsylvania; and 6 University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan

Requests for reprints: G. Thomas Budd, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk R35, Cleveland, OH 44195. Phone: 216-444-6480; Fax: 216-445-2369; E-mail: buddg{at}ccf.org.

Purpose: The presence of ≥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 ~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 ≥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 ≥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.


Commentary

Circulating Tumor Cells in Breast Cancer: Blood Will Tell
George W. Sledge, Jr.
Clin. Cancer Res. 2006 12: 6321-6322. [Full Text] [PDF]



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Molecular Cancer Research Cancer Prevention Research
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Copyright © 2006 by the American Association for Cancer Research.