Circulating tumor cells and [18F]fluorodeoxyglucose positron emission tomography/computed tomography for outcome prediction in metastatic breast cancer

Ugo De Giorgi, Vicente Valero, Eric Rohren, Shaheenah Dawood, Naoto T. Ueno, M. Craig Miller, Gerald V. Doyle, Summer Jackson, Eleni Andreopoulou, Beverly C. Handy, James M. Reuben, Herbert A. Fritsche, Homer A. Macapinlac, Gabriel N. Hortobagyi, Massimo Cristofanilli

Research output: Contribution to journalArticle

Abstract

Purpose: Circulating tumor cells (CTCs) and [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) are two new promising tools for therapeutic monitoring. In this study, we compared the prognostic value of CTC and FDG-PET/CT monitoring during systemic therapy for metastatic breast cancer (MBC). Patients and Methods: A retrospective analyses of 115 MBC patients who started a new line of therapy and who had CTC counts and FDG-PET/CT scans performed at baseline and at 9 to 12 weeks during therapy (midtherapy) was performed. Patients were categorized according to midtherapy CTC counts as favorable (ie, <five CTCs/7.5 mL blood) or unfavorable (≥ five CTCs/7.5 mL blood) outcomes. CTC counts and FDG-PET/CT response at midtherapy were compared, and univariate and multivariate analyses were performed to identify factors associated with survival. Results: In 102 evaluable patients, the median overall survival time was 14 months (range, 1 to > 41 months). Midtherapy CTC levels correlated with FDG-PET/CT response in 68 (67%) of 102 evaluable patients. In univariate analysis, midtherapy CTC counts and FDG-PET/CT response predicted overall survival (P <.001 and P = .001, respectively). FDG-PET/CT predicted overall survival (P = .0086) in 31 (91%) of 34 discordant patients who had fewer than five CTCs at midtherapy. Only midtherapy CTC levels remained significant in a multivariate analysis (P = .004). Conclusion: Detection of five or more CTCs during therapeutic monitoring can accurately predict prognosis in MBC beyond metabolic response. FDG-PET/CT deserves a role in patients who have fewer than five CTCs at midtherapy. Prospective trials should evaluate the most sensitive and cost-effective modality for therapeutic monitoring in MBC.

Original languageEnglish
Pages (from-to)3303-3311
Number of pages9
JournalJournal of Clinical Oncology
Volume27
Issue number20
DOIs
Publication statusPublished - Jul 10 2009

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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    De Giorgi, U., Valero, V., Rohren, E., Dawood, S., Ueno, N. T., Miller, M. C., Doyle, G. V., Jackson, S., Andreopoulou, E., Handy, B. C., Reuben, J. M., Fritsche, H. A., Macapinlac, H. A., Hortobagyi, G. N., & Cristofanilli, M. (2009). Circulating tumor cells and [18F]fluorodeoxyglucose positron emission tomography/computed tomography for outcome prediction in metastatic breast cancer. Journal of Clinical Oncology, 27(20), 3303-3311. https://doi.org/10.1200/JCO.2008.19.4423