Presence of Circulating Tumor Cells in High-Risk Early Breast Cancer During Follow-Up and Prognosis. (11th October 2018)

• Record Type: Journal Article
• Authors: Trapp, Elisabeth; Janni, Wolfgang; Schindlbeck, Christian; Jückstock, Julia; Andergassen, Ulrich; de Gregorio, Amelie; Alunni-Fabbroni, Marianna; Tzschaschel, Marie; Polasik, Arkadius; Koch, Julian G; Friedl, Thomas W P; Fasching, Peter A; Haeberle, Lothar; Fehm, Tanja; Schneeweiss, Andreas; Beckmann, Matthias W; Pantel, Klaus; Mueller, Volkmar; Rack, Brigitte; Scholz, Christoph
• Is Part Of: Journal of the National Cancer Institute. Volume 111:Number 4(2019)
• Page Start: 380
• Page End: 387
• Publication Date: 2018-10-11
• Subjects: Cancer -- Periodicals; Cancer -- Research -- Periodicals; 616.994
• DOI: 10.1093/jnci/djy152
• Languages: English
• ISSNs: 0027-8874

Abstract

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.