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Change in Course of Treatment: Exploring Better Ways

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Before initiation of the first treatment (baseline), 53 percent of patients had no detectable CTC. These patients had superior median survival times compared with those patients who had circulating tumor cells. A favorable CTC number before treatment is associated with better progression free survival and overall survival.

In addition to its predictive value at baseline, the CTC was also a strong indicator of prognosis as early as 3-5 weeks after treatment initiation. "Patients with unfavorable CTC had a shorter median survival time. This was even seen in those patients whose CT scan the gold standard for tumor evaluation- indicated no disease progression," Meropol explained.

The median overall survival of patients with a favorable CTC before treatment was almost double that of those with an unfavorable CTC (18.5 months vs. 9.4 months). Patients with a favorable CTC had a median progression free survival of 7.9 months and those with an unfavorable CTC had a progression free survival of 4.5 months. The measurement of CTCs consistently provided prognostic information even when tested at 6-12 weeks.

Another key finding was the predictive value of a change in CTC. Among patients with unfavorable CTC at baseline, those whose numbers decreased after treatment to fewer than 3 had improved progression-free survival and overall survival.

"Potentially, this tool could be useful in the clinic to make real-time decisions about whether a treatment is helping. Our ultimate goal is to continue effective treatment, but spare patients the side effects of a treatment that is destined to fail. This is the direction that future studies must take."


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