Geburtshilfe Frauenheilkd 2016; 76 - FV010
DOI: 10.1055/s-0036-1593247

Detection of circulating tumor cells during long-term follow-up of high-risk breast cancer patients indicates poor prognosis – results of the adjuvant SUCCESS A trial

E Trapp 1, B Rack 1, TW Friedl 2, L Häberle 3, H Tesch 4, R Lorenz 5, J Jückstock 1, M Tzschaschel 1, M Alunni-Fabbroni 1, A Schramm 1, J Koch 1, B Jäger 6, V Müller 7, S Mahner 1, T Fehm 6, A Schneeweiss 8, MW Beckmann 3, W Lichtenegger 9, C Scholz 2, W Janni 2
  • 1Ludwig-Maximilians University, Munich, Deutschland
  • 2University of Ulm, Ulm, Deutschland
  • 3Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Deutschland
  • 4Haemato-Oncology Practice, Bethanien Hospital, Frankfurt, Deutschland
  • 5Gynecology Practice Lorenz/Hecker/Wesche, Braunschweig, Deutschland
  • 6Heinrich-Heine University Duesseldorf, Duesseldorf, Deutschland
  • 7University Hospital Hamburg-Eppendorf, Hamburg, Deutschland
  • 8Ruprecht-Karls University, Heidelberg, Deutschland
  • 9Charité University Hospital Campus Virchow, Berlin, Deutschland

Purpose: Recent data suggest that circulating tumor cells (CTCs) are of prognostic relevance in early and metastatic breast cancer (BC). However, there is a lack of information regarding the prognostic impact of detected CTCs during long-term follow-up.

Methods: The multicenter, open label, Phase III trial SUCCESS A compared two adjuvant chemotherapy regimens followed by 2 versus 5 years of zoledronate in high-risk early BC patients. CTCs were assessed before and 2 years after chemotherapy using the FDA approved CellSearch System (Janssen Diagnostics, LLC). CTC-positivity was defined as ≥1 CTC in 7.5 ml whole blood. Overall survival (OS) and disease-free survival (DFS) were analyzed by univariate log-rank tests and multivariate Cox regressions. Overall and disease-free survival was measured from the date of follow-up CTC assessment.

Results: Out of the 3754 patients randomized, data on CTC-status before and two years after chemotherapy were available in 1087 patients. Median follow-up was 37 months. Two years after chemotherapy 198 (18.2%) patients were CTC positive. Cox regressions including CTC-status before chemotherapy showed significant independent prognostic relevance of CTC-status 2 years after chemotherapy on OS (hazard ratio (HR) 3.82, 95% confidence interval (CI) 1.99 – 7.31, p < 0.001) and DFS (HR 2.28, 95% CI 1.48 – 3.50, p < 0.001).

Tumor specific analyses revealed that CTC-positivity during follow-up indicated poor prognosis particularly in luminal and triple-negative tumors.

Conclusion: CTC-positivity two years after adjuvant chemotherapy was associated with decreased OS and DFS. Therefore, CTCs assessed during long-term follow-up may serve as a surveillance marker.