Serial Analysis of Circulating Tumor Cells in Metastatic Breast Cancer Receiving First-Line Chemotherapy.

Journal Article (Journal Article)

BACKGROUND: We examined the prognostic significance of circulating tumor cell (CTC) dynamics during treatment in metastatic breast cancer (MBC) patients receiving first-line chemotherapy. METHODS: Serial CTC data from 469 patients (2202 samples) were used to build a novel latent mixture model to identify groups with similar CTC trajectory (tCTC) patterns during the course of treatment. Cox regression was used to estimate hazard ratios for progression-free survival (PFS) and overall survival (OS) in groups based on baseline CTCs, combined CTC status at baseline to the end of cycle 1, and tCTC. Akaike information criterion was used to select the model that best predicted PFS and OS. RESULTS: Latent mixture modeling revealed 4 distinct tCTC patterns: undetectable CTCs (56.9% ), low (23.7%), intermediate (14.5%), or high (4.9%). Patients with low, intermediate, and high tCTC patterns had statistically significant inferior PFS and OS compared with those with undetectable CTCs (P < .001). Akaike Information Criterion indicated that the tCTC model best predicted PFS and OS compared with baseline CTCs and combined CTC status at baseline to the end of cycle 1 models. Validation studies in an independent cohort of 1856 MBC patients confirmed these findings. Further validation using only a single pretreatment CTC measurement confirmed prognostic performance of the tCTC model. CONCLUSIONS: We identified 4 novel prognostic groups in MBC based on similarities in tCTC patterns during chemotherapy. Prognostic groups included patients with very poor outcome (intermediate + high CTCs, 19.4%) who could benefit from more effective treatment. Our novel prognostic classification approach may be used for fine-tuning of CTC-based risk stratification strategies to guide future prospective clinical trials in MBC.

Full Text

Duke Authors

Cited Authors

  • Magbanua, MJM; Hendrix, LH; Hyslop, T; Barry, WT; Winer, EP; Hudis, C; Toppmeyer, D; Carey, LA; Partridge, AH; Pierga, J-Y; Fehm, T; Vidal-Martínez, J; Mavroudis, D; Garcia-Saenz, JA; Stebbing, J; Gazzaniga, P; Manso, L; Zamarchi, R; Antelo, ML; Mattos-Arruda, LD; Generali, D; Caldas, C; Munzone, E; Dirix, L; Delson, AL; Burstein, HJ; Qadir, M; Ma, C; Scott, JH; Bidard, F-C; Park, JW; Rugo, HS

Published Date

  • April 6, 2021

Published In

Volume / Issue

  • 113 / 4

Start / End Page

  • 443 - 452

PubMed ID

  • 32770247

Pubmed Central ID

  • PMC8023821

Electronic International Standard Serial Number (EISSN)

  • 1460-2105

Digital Object Identifier (DOI)

  • 10.1093/jnci/djaa113


  • eng

Conference Location

  • United States