Insulin-like growth factor-1 receptor (IGF-1R) expression on circulating tumor cells (CTCs) and metastatic breast cancer outcome: results from the TransMYME trial

Alessandra Gennari, Flavia Foca, Rita Zamarchi, Andrea Rocca, Dino Amadori, Andrea De Censi, Alessandra Bologna, Luigi Cavanna, Lorenzo Gianni, Laura Scaltriti, Elisabetta Rossi, Antonella Facchinetti, Veronica Martini, Paolo Bruzzi, Oriana Nanni

Research output: Contribution to journalArticle


Purpose: To evaluate the prognostic value of IGF-1R expression on circulating tumor cells (CTCs) in a prospective randomized clinical trial comparing chemotherapy plus metformin with chemotherapy alone in metastatic breast cancer (MBC) patients. Methods: CTCs were collected at baseline and at the end of chemotherapy. An automated sample preparation and analysis system (CellSearch) were customized for detecting IGF-1R expression. The prognostic role of CTC count and IGF-1R was assessed for PFS and OS by univariate and multivariate analyses. Results: Seventy-two out of 126 randomized patients were evaluated: 57% had ≥ 1 IGF-1R positive CTC and 37.5% ≥ 4 IGF-1R negative cells; 42% had CTC count ≥ 5/7.5 ml. At univariate analysis, the number of IGF-1R negative CTCs was strongly associated with risk of progression and death: HR 1.93 (P = 0.013) and 3.65 (P = 0.001), respectively; no association was detected between number of IGF-1R positive CTCs and PFS or OS (P = 0.322 and P = 0.840). The prognostic role of CTC count was confirmed: HR 1.69, P = 0.042 for PFS and HR 2.80 for OS, P = 0.002. By multivariate analysis, the prognostic role of the number of IGF-1R negative CTCs was maintained, while no residual prognostic role of CTC count or number of IGF-1R positive cells was found. Conclusion: Loss of IGF-1R in CTCs is associated with a significantly worse outcome in MBC patients. This finding supports further evaluation for the role of IGF-1R on CTCs to improve patient stratification and to implement new targeted strategies. Clinical trial registration: (NCT01885013); European Clinical Trials Database (EudraCT No.2009-014,662-26).

Original languageEnglish
JournalBreast Cancer Research and Treatment
Publication statusAccepted/In press - Jan 1 2020



  • Breast cancer (BC)
  • Circulating tumor cells (CTCs)
  • Clinical trials
  • Invasion
  • Liquid biopsy
  • Metastasis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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