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Wandering Tumor Cells Predict Poor Outcome

Circulating Tumor Cells Linked to Higher Risk of Recurrence, Death in Breast Cancer

By Charlene Laino
WebMD Health News

Reviewed by Laura J. Martin, MD

Dec. 10, 2010 (San Antonio) -- Women with metastatic breast cancer who have no tumor cells circulating in their blood after the first round of treatment live longer than those who do, French researchers report.

Circulating tumor cells, or CTCs, are cells that break off from a tumor and escape into the bloodstream. These cells can travel to other organs and establish new tumors.

Several studies have shown that higher levels of CTCs are associated with an increased risk for recurrence and death in metastatic breast cancer patients.

But the new study is the largest to look at the topic, and the CTCs predicted prognosis even after taking other markers of survival into account, says Jean-Yves Pierga, MD, PhD, professor of the medical oncology department at Institut Curie and Universite Paris Descartes, France.

The study also suggests CTCs can be used to monitor whether a woman is responding to treatment, he tells WebMD.

Pierga reported the findings at the annual San Antonio Breast Cancer Symposium.

Circulating Tumor Cells Predict Breast Cancer Progression

The study involved 267 women whose cancer had spread to other parts of their body (metastasized) and who were receiving chemotherapy with or without the targeted drug Avastin for the first time.

Before treatment, two-thirds of the women had one or more CTCs; 44% had five or more CTCs.

After two years, cancer had progressed in about 95% of those with five or more CTCs, compared with about 70% of those with fewer or no CTCs.

Looked at another way, women with five or more CTCs were 90% more likely to have their cancer worsen and nearly two-and-a-half times more likely to die, even after other tumor markers were taken into account, Pierga says.

Then the researchers looked at women's CTC levels after their first round of treatment. At two years, cancer had progressed in about 70% of those with fewer than five CTCs, but in all of those with more CTCs. Over 90% of those with fewer than five CTCs were still alive, compared with less than half of the women with more CTCs.

The study also showed that after three rounds of treatment, CTCs dropped more in women who received Avastin plus chemotherapy, compared with those who just got chemo.

Doctors Divided on Usefulness of CTC Testing

Still, doctors appear divided on whether CTC testing is useful.

Alison T. Stopeck, MD, director of the Clinical Breast Cancer Program at the Arizona Cancer Center in Tucson, says she doesn't use the CTC test at all.

"More often than not, I know which of my patients with metastatic breast cancer are progressing just by examining them," she tells WebMD.

Plus a high CTC count doesn't provide any information about what treatment might help, Stopeck says.

Minetta Liu, MD, director of translational breast cancer research at Georgetown Lombardi Comprehensive Cancer Center in Washington D.C., says the test is very useful.

"I use every tool I have," she tells WebMD. In some cases, knowing a woman has no CTCs allows her to delay much more expensive imaging tests to track the progress of the cancer, Liu says.

Early Breast Cancer

Also at the meeting, U.S. researchers reported that having even one CTC in the blood increases the risk of recurrence and death in women with early-stage breast cancer.

The study involved about 2,000 women with early cancer, nearly one-fourth of whom had CTCs in their blood.

After three years, about 5% of those with no CTCs relapsed vs. about 85% of those with CTCs. About 96% of those with no CTCs and 93% of those with CTCs were alive, says researcher Brigitte Rack, MD, head of the department of gynecological oncology at the Women's Hospital at the University of Munich, Germany.

"We don't have markers for prognosis or to tell us if a treatment is working," Rack tells WebMD. "If we had an early marker, it could help us to see if a different treatment might be better."

Still, CTC testing is not ready for prime time in women with early breast cancer, Rack and Liu say.

"We don't know what options to offer if a woman does have CTCs," Rack says.

Several studies looking at whether CTC testing can improve survival in early breast cancer are ongoing in Europe and the United States, she says.

This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

SOURCES: San Antonio Breast Cancer Symposium, Dec. 8-12, 2010.Jean-Yves Pierga, MD, PhD, professor, medical oncology department, Institut Curie and Universite Paris Descartes, France.Alison T. Stopeck, MD, director, Clinical Breast Cancer Program, Arizona Cancer Center, Tucson.Minetta Liu, MD, director of translational breast cancer research, Georgetown Lombardi Comprehensive Cancer Center, Washington D.C.,Brigitte Rack, MD, head, department of gynecological oncology, Women's Hospital, University of Munich, Germany.

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