Evaluation and Prognostic Significance of Circulating Tumor Cells in Patients With Non–Small-Cell Lung Cancer

American Society of Clinical Oncology
Evaluation and Prognostic Significance of Circulating Tumor Cells in Patients With Non–Small-Cell Lung Cancer
Matthew G. Krebs, Robert Sloane, Lynsey Priest, Lee Lancashire, Jian-Mei Hou, Alastair Greystoke, Tim H. Ward, Roberta Ferraldeschi, Andrew Hughes, Glen Clack, Malcolm Ranson, Caroline Dive and Fiona H. Blackhall

+ Author Affiliations

From the Clinical and Experimental Pharmacology Group, Paterson Institute for Cancer Research; The Christie National Health Service Foundation Trust; University of Manchester; Manchester Cancer Research Centre; Manchester Academic Health Sciences Centre, Manchester; and AstraZeneca Pharmaceuticals, Adderley Park, United Kingdom.

↵Corresponding author: Caroline Dive, PhD, Paterson Institute for Cancer Research, Wilmslow Rd, Manchester, M20 4BX United Kingdom; e-Mail: cdive@picr.man.ac.uk.


Abstract
Purpose Lung cancer is the leading cause of cancer-related death worldwide. Non–small-cell lung cancer (NSCLC) lacks validated biomarkers to predict treatment response. This study investigated whether circulating tumor cells (CTCs) are detectable in patients with NSCLC and what their ability might be to provide prognostic information and/or early indication of patient response to conventional therapy.

Patients and Methods
In this single-center prospective study, blood samples for CTC analysis were obtained from 101 patients with previously untreated, stage III or IV NSCLC both before and after administration of one cycle of standard chemotherapy. CTCs were measured using a semiautomated, epithelial cell adhesion molecule–based immunomagnetic technique.

Results
The number of CTCs in 7.5 mL of blood was higher in patients with stage IV NSCLC (n = 60; range, 0 to 146) compared with patients with stage IIIB (n = 27; range, 0 to 3) or IIIA disease (n = 14; no CTCs detected). In univariate analysis, progression-free survival was 6.8 v 2.4 months with P < .001, and overall survival (OS) was 8.1 v 4.3 months with P < .001 for patients with fewer than five CTCs compared with five or more CTCs before chemotherapy, respectively. In multivariate analysis, CTC number was the strongest predictor of OS (hazard ratio [HR], 7.92; 95% CI, 2.85 to 22.01; P < .001), and the point estimate of the HR was increased with incorporation of a second CTC sample that was taken after one cycle of chemotherapy (HR, 15.65; 95% CI, 3.63 to 67.53; P < .001).

Conclusion
CTCs are detectable in patients with stage IV NSCLC and are a novel prognostic factor for this disease. Further validation is warranted before routine clinical application.

Footnotes
See accompanying article doi: 10.1200/JCO.2010.30.5151 and editorial doi: 10.1200/JCO.2010.34.0026

Received February 12, 2010.
Accepted June 29, 2010.
Evaluation and Prognostic Significance of Circulating Tumor Cells in Patients With Non–Small-Cell Lung Cancer




ONCOLOGÍA
El recuento de células del cáncer de pulmón permite hacer un mejor pronóstico de la enfermedad
JANO.es y agencias · 23 Marzo 2011 12:34


.Medir el número de células tumorales circulantes también puede ayudar a decidir el tratamiento más adecuado y a monitorizar la respuesta.



Científicos del Christie Cancer Hospital de Manchester (Reino Unido) aseguran que el recuento de las células tumorales en pacientes con cáncer de pulmón puede servir para determinar la gravedad de la enfermedad y decidir cuál es el mejor tratamiento en cada caso.

Así se desprende de un estudio que publica el último número del Journal of Clinical Oncology, en el que ha contabilizado el número de células tumorales circulantes (CTC) en muestras de sangre de un total de 101 pacientes con cáncer de pulmón, tomadas antes y después de someterse a un ciclo de quimioterapia.

De este modo, observaron que quienes presentaban más de 5 CTC en 7,5 ml de sangre presentaban una tasa de supervivencia global de 4,3 meses de media, unos datos “significativamente peores” que aquellos que presentaban menos de 5 CTC, cuya supervivencia media fue de 8,1 meses.

Los resultados sugieren que el recuento de los CTC podría ser una forma sencilla para saber cómo un paciente está respondiendo al tratamiento a las pocas semanas de iniciarlo.

“Ahora tenemos que poner a prueba este hallazgo en más pacientes pero, si los resultados se confirman, existe la posibilidad de adaptar los tratamientos a los pacientes individuales y encontrar nuevas formas de tratar la enfermedad”, asegura Fiona Blackhall, autora del estudio.



JCO 2011; DOI:10.1200/JCO.2010.28.7045
Evaluation and Prognostic Significance of Circulating Tumor Cells in Patients With Non–Small-Cell Lung Cancer

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