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Imaging, Diagnosis, Prognosis |
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
Clin. Cancer Res. 2006 12: 6321-6322.
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