Presence of Circulating Tumor Cells in High-Risk Early Breast Cancer During Follow-Up and Prognosis.

Abstract

BACKGROUND:

The prognostic relevance of circulating tumor cells (CTCs) at the time of primary diagnosis has been well established. However, little information is available regarding their prognostic relevance to follow-up care.

METHODS:

The multicenter, open-label, phase III SUCCESS A trial compared two adjuvant chemotherapy regimens followed by 2 vs 5 years of zoledronate for early-stage, high-risk breast cancer patients. The presence of CTCs was assessed before and 2 years after chemotherapy using the FDA-approved CellSearch System. Overall survival (OS) and disease-free survival (DFS) were analyzed using univariate log-rank tests and multivariable Cox regressions. OS and DFS were measured starting from an assessment of CTCs 2 years after the completion of chemotherapy. All statistical tests were two-sided.

RESULTS:

The sample included 1087 patients who participated in the translational research program of the SUCCESS A trial and for whom sufficient translational data were available regarding CTC status at baseline and at the 2-year follow-up visit. Two years after chemotherapy, 198 (18.2%) patients were CTC-positive. The median follow-up after this timepoint was 37 months. Cox regressions that included CTC status at baseline revealed that CTC status 2 years after chemotherapy had statistically significant and independent prognostic relevance for OS (hazard ratio [HR] = 3.91, 95% confidence interval [CI] = 2.04 to 7.52, P < .001) and DFS (HR = 2.31, 95% CI = 1.50 to 3.55, P < .001).

CONCLUSION:

The presence of CTCs 2 years after chemotherapy was associated with decreased OS and DFS. Based on these results, active individualized surveillance strategies for breast cancer survivors based on biomarkers should be reconsidered.

• Authors: Elisabeth Trapp, Wolfgang Janni, Christian Schindlbeck, Julia Jückstock, Ulrich Andergassen, Amelie de Gregorio, Marianna Alunni-Fabbroni, Marie Tzschaschel, Arkadius Polasik, Julian G Koch, Thomas W P Friedl, Peter A Fasching, Lothar Haeberle, Tanja Fehm, Andreas Schneeweiss, Matthias W Beckmann, Klaus Pantel, Volkmar Mueller, Brigitte Rack, Christoph Scholz, SUCCESS Study Group
• Journal: Journal of the National Cancer Institute (J Natl Cancer Inst) Vol. 111 Issue 4 Pg. 380-387 (04 01 2019) ISSN: 1460-2105 [Electronic] United States
• PMID: 30312434 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Breast Neoplasms (blood, drug therapy, pathology)
• Carcinoma, Ductal, Breast (blood, drug therapy, pathology)
• Carcinoma, Lobular (blood, drug therapy, pathology)
• Female
• Follow-Up Studies
• Humans
• Middle Aged
• Neoplastic Cells, Circulating (drug effects, pathology)
• Prognosis
• Prospective Studies
• Risk Factors
• Survival Rate
• Young Adult