Circulating tumour cells and pathological complete response: independent prognostic factors in inflammatory breast cancer in a pooled analysis of two multicentre phase II trials (BEVERLY-1 and -2) of neoadjuvant chemotherapy combined with bevacizumab

Abstract

In this pooled analysis of two prospective trials in nonmetastatic IBC, detection rate of CTC was 39% with a strong and independent prognostic value for survival. Combination of pCR after neoadjuvant treatment with no CTC detection at baseline isolated a subgroup of IBC with excellent OS (94% 3-year OS), suggesting that CTC count could be part of IBC stratification in prospective trials.

EpCAM-independent isolation of circulating tumor cells with epithelial-to-mesenchymal transition and cancer stem cell phenotypes using ApoStream® in patients with breast cancer treated with primary systemic therapy

“…In a more recent meta-analysis of 2090 patients treated with neoadjuvant chemotherapy, CTC detection-before neoadjuvant chemotherapy or before surgery-by CellSearch was also not able to demonstrate a correlation between CTC numbers and pCR [30]. One explanation could be the increased numbers of CTCs detected during treatment in our study, whereas most of the studies highlighted a decrease in CTCs during neoadjuvant treatment that reflected tumor load [28,30,31]. This higher CTC detection rate over treatment could be due to the high vascularity and metastatic…”

“…CTCs are known to be detected in a large number of patients with newly diagnosed metastatic IBC (84%, versus 55% of stage III patients) [32]. In a pooled analysis of two prospective trials in patients with nonmetastatic IBC, using bevacizumab, the CTC detection rate proved to be an independent prognostic factor of overall survival [31]. Moreover, association of pCR status and CTC detection at baseline helped isolate a subgroup of IBC patients with excellent survival (94% 3-year overall survival) [31].…”

Liquid biopsies

“…In 3173 patients with nonmetastatic (stage I‐III) breast cancer, the presence of CTCs was found to be an independent predictor of poor disease‐free, overall, breast cancer‐specific, and distant disease‐free survival . In a pooled analysis of two prospective trials in nonmetastatic inflammatory breast cancer, in patients treated with neoadjuvant chemotherapy combined with neoadjuvant and adjuvant bevacizumab, detection rate of CTC was 39% with a strong and independent prognostic value for survival, while combination of pCR after neoadjuvant treatment with no CTC detection at baseline isolated a subgroup of inflammatory breast cancer patients with excellent overall survival (OS), suggesting that CTC count could be part of inflammatory breast cancer stratification in prospective trials …”

“…42 In a pooled analysis of two prospective trials in nonmetastatic inflammatory breast cancer, in patients treated with neoadjuvant chemotherapy combined with neoadjuvant and adjuvant bevacizumab, detection rate of CTC was 39% with a strong and independent prognostic value for survival, while combination of pCR after neoadjuvant treatment with no CTC detection at baseline isolated a subgroup of inflammatory breast cancer patients with excellent overall survival (OS), suggesting that CTC count could be part of inflammatory breast cancer stratification in prospective trials. 43 In the SUCCESS study, a multi-center, prospective, randomized trial, CTCs were detected in patients without signs of breast cancer recurrence when analyzed in peripheral blood using the FDA cleared CellSearch System 2 and 5 years after primary diagnosis. 44 According to the latest findings of the SUCCESS study, the presence of CTCs in high-risk early breast cancer patients during follow-up care suggests poor prognosis (E. Trapp et al, JNCI, in press).…”

Circulating tumor cells in breast cancer

“…CTC detection at baseline independently predicted the significant difference in 3-year DFS (70% vs. 39% for patients with < 1 vs. ≥ 1 CTC/7.5 mL and 3-year OS [92% vs. 56%]). [29] Circulating Tumor Cells in HER2+ Breast Cancer Yet, another poor prognostic factor in the outcome of breast cancer patients is HER2 overexpression. Wulfing et al and Hayashi et al have reported the poor prognostic value of HER2+ CTC in comparison to HER2-CTC in patients with EBC and MBC, respectively.…”