Circulating tumor cells in newly diagnosed inflammatory breast cancer

Abstract

IntroductionCirculating tumor cells (CTCs) are an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer. Inflammatory breast cancer (IBC) is one of the most aggressive forms of breast cancer. The prognostic value of a CTC count in newly diagnosed IBC has not been established. The aim of this study was to assess the prognostic value of a baseline CTC count in patients with newly diagnosed IBC.MethodsThis retrospective study included 147 patients with newly diagnosed IBC (77 with locally advanced and 70 with metastatic IBC) treated with neoadjuvant therapy or first-line chemotherapy during the period from January 2004 through December 2012 at The University of Texas MD Anderson Cancer Center. CTCs were detected and enumerated by using the CellSearch system before patients were started with chemotherapy.ResultsThe proportion of patients with ≥1 CTC was lower among patients with stage III than among patients with metastatic IBC (54.5% versus 84.3%; P = 0.0002); the proportion of patients with ≥5 CTCs was also lower for stage III than for metastatic IBC (19.5% versus 47.1%; P = 0.0004). Patients with fewer than five CTCs had significantly better progression-free survival (PFS) (hazard ratio (HR) = 0.60; P = 0.02) and overall survival (HR = 0.59; P = 0.03) than patients with five or more CTCs. Among patients with stage III IBC, there was a nonsignificant difference in PFS (HR = 0.66; 95% confidence interval (CI), 0.31 to 1.39; P = 0.29) and OS (HR = 0.54; 95% CI, 0.24 to 1.26; P = 0.48) in patients with no CTCs compared with patients with one or more CTCs. In multivariate analysis, CTC was prognostic for PFS and OS independent of clinical stage.ConclusionsCTCs can be detected in a large proportion of patients with newly diagnosed IBC and are a strong predictor of worse prognosis in patients with newly diagnosed IBC.

Characterization of circulating tumor cells in newly diagnosed breast cancer

“…Although the breast cancers examined were not metastatic with the likely possibility of a low and difficult to detect frequency of CTCs, the present study revealed a relatively higher sensitivity (90.76%) in CTC detection of breast cancer compare with the sensitivity of 54.5% in a previously study (8), in which CTC were detected using CELLSEARCH ® system. The high sensitivity of CTC detection in breast cancer were identical to that of other solid tumors evaluated with the iFISH system, including gastric (90.5%) (15), lung (92%) and esophageal (87%) cancer (5).…”

“…In metastatic breast cancer, the Food and Drug Administration approved the CELLSEARCH ® system for routine clinical use in guiding clinical management (7). However, few studies (4,8) have been published in CTC detection for breast cancer prior to metastasis. Mammaglobin-positive CTC detection has previously been performed in women suspected of breast cancer; however, it failed to detect intraductal cancer and 50% of in situ cancers (4).…”

“…Mammaglobin-positive CTC detection has previously been performed in women suspected of breast cancer; however, it failed to detect intraductal cancer and 50% of in situ cancers (4). CTCs also be detected in newly diagnosed inflammatory breast cancer using CELLSEARCH system, which result in a proportion of 54.5% non-metastatic patients with >1 CTCs (8).…”

Circulating tumor cells in breast cancer

“…Interestingly, epithelial and mesenchymal patterns were different across tumor subtypes and were also dynamic during therapy, mesenchymal CTC being frequently observed at the time of tumor progression. Several other studies reported some mesenchymal traits on detected BC CTC (Armstrong et al., 2011; Mego et al., 2015a,b, 2012; Papadaki et al., 2014), but the clinical impact of these cells has not been demonstrated yet. Stemness‐related features have been also detected on BC CTC (Raimondi et al., 2011).…”

Circulating tumor cell interactions with macrophages: implications for biology and treatment

“…CTC count among 147 patients with IBC reached 179 and 249 CTCs/7.5 mL blood for patients with stage III and metastatic IBC, respectively (71). IBC patients with CTCs in the peripheral blood had abnormalities in adaptive immunity that may impact tumor cell dissemination (72). IBC carcinoma tissues exhibit marked monocytes/ macrophages infiltrates localized around tumor emboli (73).…”