Counting Circulating Tumor Cells - Breast cancer
From: J (acadian_at_example.net)
Date: 11/14/04
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Date: Sat, 13 Nov 2004 19:38:27 -0500
http://www.landesbioscience.com/journals/cbt/news.php?id=1285
Vol: 3 | Issue: 11 | November | News
A new blood test could change the way doctors treat women whose breast
cancer has spread to other parts of their body.
Using a technology that separates the cancer cells circulating in the
blood of women with metastatic breast cancer, doctors are able to count
these cells and determine within just three to four weeks whether a new
treatment is working.
"If you've started a new therapy, three to four weeks later it's usually
too early for us to even begin to tell if the therapy is working. With
this test, if you have elevated levels of cancer cells in your blood after
three weeks of treatment, it's very likely your disease is going to
progress quickly and it means probably you're on the wrong therapy," says
Daniel Hayes, M.D., clinical director of the Breast Oncology Program at
the University of Michigan Comprehensive Cancer Center.
Traditionally, the most reliable way to determine if a therapy is
effective is to run CT scans, bone scans and chest X-rays. But it takes
three to four months of treatment before those tests will show if the
treatment is making a difference. Other methods, such as examining the
patient or running other blood tests, are usually not accurate.
The idea of counting cancer cells in the blood is not new, but the
techniques used until this point have been unreliable. This new method,
using a technology called CellSearch, produces the same results every
time. CellSearch was developed by Immunicon Corp. in Huntington Valley,
Pa., and is marketed by Veridex LLC, a Johnson & Johnson company.
About 250,000 women will be diagnosed with breast cancer this year, and 15
percent to 20 percent of patients will ultimately develop metastasis.
Breast cancer most commonly spreads to the liver, lungs or bones.
"Once a patient has developed metastatic breast cancer that we can find in
the bones, the liver or the lung, we rarely, if ever, cure such a patient.
We can treat her, but not as well as we'd like. And our goal of therapy
for such a patient is to keep her quality of life as good as it can be,
for as long as it can be," says Hayes, professor of Internal Medicine at
the U-M Medical School.
Treatment involves hormone therapy or chemotherapy, and oncologists have
many different options to choose from. If one therapy proves ineffective,
doctors may be able to switch the patient to a different treatment.
"The clinician has two challenges," Hayes says. "One is which therapy is
likely to work - and there may be several - with the fewest side effects.
Then we have to wait and see whether that was the right choice because
these therapies don't work in 100 percent of patients. And so the second
challenge is, as a doctor, did I pick the right therapy to achieve that
balance?"
The benefit of this new test is patients would not have to spend months
taking a drug - and dealing with its side effects - if it's not working.
In a multicenter trial of the CellSearch technology, published in August
in the New England Journal of Medicine, researchers at U-M and elsewhere
found that in women who had elevated circulating tumor cell levels three
to four weeks after beginning a new therapy, the cancer progressed within
three months, compared to almost seven months progression-free for women
with lower tumor cell levels. The women also had shorter survival when
tumor cell levels were elevated: 10 months survival in the elevated group,
compared to more than 18 months if levels were low.
"I really think this could help us change the way we treat patients with
metastatic disease by making better decisions and treating them more
efficiently. By not prolonging therapy that's not likely to work, we can
go to therapy that might be more likely to work," Hayes says.[end quoted
text[
http://www.med.umich.edu/opm/newspage/2004/tumorcell.htm
August 18, 2004
Tumor cell levels in blood predict success of advanced-stage breast cancer
treatment
These researchers determined that about half of 177 women in the study
whose breast cancer had metastasized, or spread, and who were starting a
new treatment had elevated levels of circulating tumor cells in their
blood system. Investigators defined an elevated level as five or more
tumor cells in a sample of blood.
Of those women, 30 percent still had higher numbers of circulating tumor
cells three to five weeks after beginning a new treatment and their cancer
progressed very rapidly compared to women whose tumor cell levels dropped
during that time or who never had elevated circulating cell levels. The
study was performed using a newly developed technology called CellSearch™
that isolates and characterizes these cells. Results of the study appear
in this week's New England Journal of Medicine.
Half of the women with metastatic breast cancer had more than five
circulating tumor cells per 7.5 ml of blood at the start of the study. The
time till their cancer progressed was less than three months for these
women, compared to almost seven months progression-free for women with
fewer than five circulating tumor cells. The women also died sooner when
tumor cell levels were above five: 10 months survival in the elevated
group, compared to more than 18 months if levels were low.
When researchers followed up with these women three to four weeks later,
only 30 percent had five or more circulating tumor cells, suggesting the
therapy was effective. Again, the cancer worsened more quickly in women
with higher tumor cell numbers, and these women had shorter survival than
women whose levels started high but dropped below five at follow-up. .[end
quoted text[
A patient on the breast cancer newsgroup who has not been confirmed with
mets, but has had every scan in the book (and repeats) for the past year
or more, has just had this test done (four circulating cells) and is
assuming that she has bone mets. http://tinyurl.com/53d89
Comments?
About this test...
Is it reliable?
Is she using this test for the wrong reason?
About the woman - is it really that difficult to differentiate between
arthritis and mets?
She has mild /treated MS. I wonder if they are humoring her by running the
tests, but aren't finding anything.
J
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