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01-01-2013 | Clinical trial

The prognostic impact of circulating tumor cells in subtypes of metastatic breast cancer

Authors: Markus Wallwiener, Andreas Daniel Hartkopf, Irène Baccelli, Sabine Riethdorf, Sarah Schott, Klaus Pantel, Frederik Marmé, Christof Sohn, Andreas Trumpp, Brigitte Rack, Bahriye Aktas, Erich-Franz Solomayer, Volkmar Müller, Wolfgang Janni, Andreas Schneeweiss, Tanja Natascha Fehm

Published in: Breast Cancer Research and Treatment | Issue 2/2013

Abstract

The detection of circulating tumor cells (CTCs) in the peripheral blood of metastatic breast cancer (MBC) patients is an independent marker of prognosis. This large prospective multicenter study aimed to assess the impact of CTCs on overall survival (OS) and progression free survival (PFS) in patients with predefined molecular subgroups of MBC. To this end, 468 MBC patients were divided into three subgroups based on immunohistochemical staining of the primary tumor: (1) hormone receptor-positive/HER2-negative (HorR+/HER2−), (2) HER2-positive (HER2+), and (3) HorR-negative/HER2-negative (HorR−/HER2−) patients. CTC status (<5 CTCs/7.5 ml blood (CTC-negative) vs. ≥5 CTCs/7.5 ml blood (CTC-positive)) was determined using the CellCearch^® system before patients started a new line of therapy. At baseline, 205 (42 %) patients were CTC-positive. On multivariate analysis, CTC-positivity was an independent prognostic factor for shorter PFS and OS. In HorR+/HER2− patients, median PFS [95 % CI] of CTC-negative versus CTC-positive patients was 8.60 [5.93–11.27] versus 4.33 [3.29–5.38] months (p < 0.001), in HER2+ patients 7.60 [5.40–9.79] versus 6.60 [4.20–9.00] months (p = 0.477) and in HorR−/HER2− patients 5.83 [5.09–6.78] versus 3.05 [1.81–4.29] months (p < 0.001), respectively. Median OS [95 % CI] of CTC-negative versus CTC-positive patients was as follows: not reached by either in the HorR+/HER2− subgroup (p < 0.001), not reached versus 18.07 [11.10–25.05] months (p = 0.001) in the HER2+ subgroup, and not reached versus 8.57 [4.07–13.07] months in the HorR−/HER2− subgroup (p = 0.001). In conclusion, our results strongly confirm the independent prognostic value of CTC enumeration in MBC patients. In contrast to recent reports, there was no association between primary tumor-based molecular subgroups and the impact of CTC status on OS. Hence, CTC status may help to identify patients who require aggressive therapy, especially among those with triple-negative MBC.

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Title: The prognostic impact of circulating tumor cells in subtypes of metastatic breast cancer
Authors: Markus Wallwiener
Andreas Daniel Hartkopf
Irène Baccelli
Sabine Riethdorf
Sarah Schott
Klaus Pantel
Frederik Marmé
Christof Sohn
Andreas Trumpp
Brigitte Rack
Bahriye Aktas
Erich-Franz Solomayer
Volkmar Müller
Wolfgang Janni
Andreas Schneeweiss
Tanja Natascha Fehm
Publication date: 01-01-2013
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 2/2013
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-012-2382-0

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