© 2007 European Society for Medical Oncology
breast cancer |
The relevance of circulating epithelial tumor cells (CETC) for therapy monitoring during neoadjuvant (primary systemic) chemotherapy in breast cancer
1 Women's Hospital
2 Clinic for Internal Medicine II
3 Institute of Pathology of the Friedrich Schiller University Jena
4 Transfusionsmedizinisches Zentrum Bayreuth
5 Women's Hospital, Helios Klinikum Berlin-Buch, Germany
* Correspondence to: Dr K. Pachmann, Abteilung für Experimentelle Hämatologie und Onkologie der Klinik für Innere Medizin II der Friedrich Schiller Universität Jena, Erlanger Allee 101, D-07747 Jena, Germany. Tel: +49-3641-9325821; Fax: +49-3641-9325827; E-mail: katharina.pachmann{at}med.uni-jena.de
Background: Having demonstrated in a previous report that the response of circulating epithelial tumor cells (CETC) during the first cycles of primary (neoadjuvant) chemotherapy perfectly reflects the response of the tumor, in the present study the changes in cell numbers during subsequent cycles and their possible impact on the therapy's outcome were examined.
Patients and methods: In 58 breast cancer patients CETC were quantified during therapy with either EC (epirubicin/ cyclophosphamid) or dose intensified E (epirubicin) followed by taxane, with or without trastuzumab, and subsequent CMF (cyclophosphamid/methorexate/ fluorouracil).
Results: CETC numbers declined more than 10-fold (good response) in 65% (her2/neu-negative) and 55% (her2/neu-positive) of patients during EC, and in 60% during dose intensified E, respectively, followed by an increase of CETC in all patients. CETC remained increased, decreasing only when adding CMF. A good initial response correlated with estrogen-receptor negativity, a poor response with early distant relapse (P < 0,0001, hazard ratio = 11.91).
Conclusion: Response of CETC already during the first cycles of neoadjuvant treatment predicts the final response of the tumor. Hitherto unknown effects of the release of tumor cells during therapy further our understanding of tumor-blood interaction and may improve access of agents like antibodies to cells. The impact on the further course of disease remains to be evaluated.
Key words: circulating tumor cells, neoadjuvant therapy monitoring
Received for publication March 27, 2007. Accepted for publication April 23, 2007.
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