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SABCS 2017: Circulating tumour cells may predict late recurrence in HR-positive breast cancer patients

08 Dec 2017

Among patients with hormone receptor (HR)-positive HER2-negative stage 2-3 breast cancer without clinical evidence of recurrence, those who had circulating tumor cells (CTC) detected in blood five years after diagnosis had an increased risk for late recurrence of breast cancer, according to data presented at the 2017 San Antonio Breast Cancer Symposium, held Dec. 5–9.

"We found that a single positive CTC assay result five years after diagnosis provides independent prognostic information for late recurrence," said Joseph A. Sparano, MD, associate director for clinical research, Montefiore Einstein Center for Cancer Care, Albert Einstein Cancer Center, New York. "This provides proof of concept that liquid biopsy-based biomarkers may be used to stratify risk for late recurrence and possibly inform treatment or clinical trial options."

Despite advances in breast cancer treatment in recent years, many women still have late recurrent disease five years or more after the initial diagnosis. HR-positive breast cancers, which make up more than half of all breast cancer cases, have an increased risk of late recurrence, noted Sparano.

"Biomarkers for late recurrence that may help guide therapy are needed," he stressed.

Participants of Sparano's study were previously enrolled in a clinical trial which assessed the addition of bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, to chemotherapy as adjuvant treatment following surgery.

Sparano and colleagues measured CTCs in blood samples from patients using the CELLSEARCH CTC assay between 4.5 and 7.5 years after an initial diagnosis of HER2-negative stage 2-3 breast cancer.

No patients had clinical evidence of recurrence at the time of enrollment.

Of patients with HR-positive breast cancer, 4.5 percent had recurrence of the disease; this compares to a recurrence rate of 0.5 percent in the HR-negative group.

Of the 546 patients enrolled in the study, 4.8 percent had a positive CTC assay result.

Among patients with HR-positive breast cancer, 5.1 percent had a positive CTC result; among those with HR-negative disease, 4.3 percent had a positive CTC result. After a median follow-up of 1.6 years, a positive CTC assay result was associated with a nearly 20-fold increased risk of breast cancer recurrence in patients with HR-positive disease.

The positive predictive value of a positive CTC assay for recurrence by two years in patients with HR-positive disease was 35 percent, and the negative predictive value for patients in this cohort was 98 percent.

A positive CTC assay was not associated with recurrence in the HR-negative group.

Sparano commented that these results were somewhat unexpected.

"We were surprised to see that 5 percent of patients had CTCs about five or more years after their initial diagnosis," he said. "Although we were expecting that CTC-positive patients would have a higher recurrence rate, we weren't expecting the risk of recurrence to be this high after a relatively short period of time."

"This study provides strong evidence of the clinical validity of the CTC assay as a prognostic biomarker for late recurrence in HR-positive breast cancer, which accounts for about one-half of all recurrences," Sparano said. "Utilizing the CTC assay for prognostic analysis may aid in a more accurate identification of patients who would most benefit from extended adjuvant endocrine therapy or other treatment options," he noted.

Next steps include studying how a single negative CTC test or serial negative tests could serve as a negative predictive marker that may allow sparing of extended adjuvant endocrine therapy beyond five or more years. Limitations of the study include short follow-up after the CTC assay, with an average time of 1.6 years.

Sparano noted that additional follow-up is required, and that further study will be necessary to determine the clinical utility of the CTC assay in this setting.

Watch the press conference for more.

Source: SABCS

017.

ER-positive breast cancer patients with more than three positive nodes or grade 3 tumors are at high risk of late recurrence after 5-year adjuvant endocrine therapy.

https://www.ncbi.nlm.nih.gov/pubmed/29042797

Here’s the cancer statistics 2018.I don’t know where to put it so I’ll put it here.

http://onlinelibrary.wiley.com/doi/10.3322/caac.21...

marijen...about you post on recurrence after 5 years on endocrine therapy. That means that it should be 10 years for those of us that fall into that category. I assume that’s me. 1 node positive. Grade 3. And my MO said the further out I get from diagnosis the less likely!!!

Remember that science has changed. Long term statistical outlooks mean that the original ocurrence and treatment were x years old.

Have hope and keep fighting.

My oncologist told me that after being a woman (huh...not changing that), the next greatest risk is being overweight, because fat produces estrogen. I think there's so much we can do with diet and exercise and just healthy living nowdays that can reduce our risk. And they are coming up with new treatments all the time. Maybe in 10 years after a mastectomy, we will have stem cell implants that can regrow healthy breast tissue. A girl can hope, right?

Hugs,

Holly

TWills.... I had both of mine out plus Fallopian tubes. No big deal as I had already gone through menopause years before being diagnosed at 58. I had a small cyst on one ovary that we were following up on every 6 months. Got tired of that and a few months after finishing chemo I wanted them out. Recovery was no big deal.

I've just started Tamoxifen two months ago and doing fine so far so I hate to mess with that, seems the newest conference data that my MO went to last month said ovaries out(in my case, pre menopause) with AI's have a slightly better % of reducing reoccurance. It's a small % and I don't want worse side effects so it's a gamble for sure. Side effects are my concern.Again, I say she said this for my case.

I am so scared.... just waiting for messages about distant metastasis... Every detail in my initial diagnosis seems to show that my prognosis is really poor. What to do with my young kids? They are under four. I am crying all day and night...

Traveltext, I appreciate the practical sincerity of your post. I tell people I fight this disease on two fronts, in my body and in my head. It's like a two headed hydra. (now I have to go listen to that song by Toto, can you tell me where I might find a hydra, is he wearing a familiar face...)

These are big issues. The biggest, really. At times it is overwhelming.

Metabolic shifts in residual breast cancer drive tumor recurrence

The researchers identified a chemical signature in the way that residual cells metabolized lipids. The altered process contributed to maintaining high levels of reactive oxygen species, which are molecules known to harm DNA. The team believes that this may play a role in triggering a relapse.

https://www.jci.org/articles/view/89914?key=67eb30...

Here’s the interpretation

https://www.medicalnewstoday.com/articles/317464.p...

Yes, but they told me antihormones are not effective in progesteronenegative cancer

Thank you for answearing... I am on AI

Anna, I agree with traveltext there is no reason to think you will recur. As time goes on you will find the fear subsides.

Dear Ann, the truth is: you can't predict what will happen to you. But right now you are disease free and should live to the maximum every moment, as much as you are physically able too. Why give cancer more of your life than you are supposed to? And there are many stage 3 women doing well after 15 years, so you shouldn't feel hopeless:

https://community.breastcancer.org/forum/67/topics...

The only thing you could do now is to focus on diet, exercise and your spiritual needs, all of which have been shown to help. Not sure how things are done in Norway, but a plant-based diet is now often recommend here. Below is a link from Dana Farber, which is one of the top 3 places to treat cancer in the US. If you search their site, you will find detailed discussion on nutrition:

http://www.dana-farber.org/health-library/videos/e...

Regular exercise is one of the most recognized ways to reduce recurrence.

Finally, studies show that people who regularly meditate or pray fare better.

I don't go to a major cancer center, because where I live there are none. But even my small treatment place gave me a set of recommendations, which included regular exercise and meditation or pray. Finally, it is also important to have normal levels of vitamin D.

If none of these help to make you feel better, perhaps you could discuss with your doctor about anti-depressants. And if your doctors can't find a way to help you lift your spirits, perhaps you should look for another one. I have a friend , stage 3 too, who changed oncologists just because the first one put to much emphasis on the negatives.

Your kids deserve their "fully operational" mom back , and there is nothing at this point to prevent that from happening.

Hugs!