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Annals of Oncology Advance Access originally published online on December 4, 2007
Annals of Oncology 2008 19(5):891-897; doi:10.1093/annonc/mdm558
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© The Author 2007. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

breast cancer

Variation of circulating tumor cell levels during treatment of metastatic breast cancer: prognostic and therapeutic implications

F. Nolé1,*, E. Munzone1, L. Zorzino2, I. Minchella1, M. Salvatici2, E. Botteri3, M. Medici1, E. Verri1, L. Adamoli1, N. Rotmensz3, A. Goldhirsch1 and M. T. Sandri2

1 Division of Medical Oncology, Medical Care Unit
2 Unit of Laboratory Medicine
3 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy

* Correspondence to: Dr F. Nolé, Medical Care Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy. Tel: +39-02-57489-460; Fax: +39-02-57489-457; E-mail: franco.nole{at}ieo.it

Background: This study aimed to evaluate the prognostic significance of circulating tumor cells (CTCs) detection in advanced breast cancer patients.

Patients and methods: We tested 80 patients for CTC levels before starting a new treatment and after 4, 8 weeks, at the first clinical evaluation and every 2 months thereafter. CTCs were detected using the CellSearch SystemTM.

Results: Forty-nine patients had ≥5 CTCs at baseline. At the multivariate analysis, baseline number of CTCs was significantly associated with progression-free survival [hazard ratio (HR) 2.5; 95% confidence interval (CI) 1.2–5.4]. The risk of progression for patients with CTCs ≥5 at last available blood draw was five times the risk of patients with 0–4 CTCs at the same time point (HR 5.3; 95% CI 2.8–10.4). Patients with rising or persistent ≥5 CTCs at last available blood draw showed a statistically significant higher risk of progression with respect to patients with <5 CTCs at both blood draws (HR 6.4; 95% CI 2.8–14.6).

Conclusion: CTCs basal value is a predictive indicator of prognosis and changes in CTC levels during therapy may indicate a clinical response. Testing CTC levels during targeted treatments might substitute other measurement parameters for response evaluation.

Key words: advanced breast cancer, breast cancer, circulating tumor cells, novel assay technology, prognostic value, tumor markers

Received for publication September 6, 2007. Revision received November 6, 2007. Accepted for publication November 7, 2007.


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