Dr. Cristofanilli on Using CTC to Stratify Patients With Breast Cancer

Massimo Cristofanilli, MD, professor of medicine (hematology and oncology), Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, discusses using circulating tumor cells (CTC) to stratify risk for patients with advanced breast cancer.

CTC detected by a liquid biopsy have long been described as being associated with bad outcomes in patients with advanced breast cancer and other tumor types but bringing utility of this approach to the clinic has been difficult, says Cristofanilli. Since the prognostic value associated with CTC was well established, investigators conducted a study to provide clinical data that they hoped would not only confirm this, but would also prove that having high levels of CTC is indicative of a different disease.

In a study presented at the 2018 ASCO Annual Meeting, investigators took data from large European cohorts, almost 2000 cases in all, and compared that information with retrospective data of approximately 500 cases from The University of Texas MD Anderson Cancer Center. Cristofanilli notes that the goal was to determine if CTC could clearly be associated with outcome irrespective of treatment line or disease subtype.

Based on the results, investigators were able to classify patients not as >5 CTC or <5 CTC, but as stage IV indolent or stage IV aggressive. In addition, stage IV aggressive disease was associated with much worse outcomes in the overall patient population and in the patients with de novo disease. Cristofanilli notes that when administering standard of care therapy, physicians should treat these stratifications as different biologies.