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Case Reports
. 2009 Apr;135(4):643-7.
doi: 10.1007/s00432-008-0498-8. Epub 2008 Oct 21.

Monitoring circulating epithelial tumour cells (CETC) to gauge therapy: in patients with disease progression after trastuzumab persisting CETC can be eliminated by combined lapatinib treatment

Oumar Camara  1 , Cornelia Jörke, Ulrike Hammer, Anne Egbe, Carola Rabenstein, Ingo B Runnebaum, Klaus Hoeffken, Katharina Pachmann
Affiliations
Case Reports

Monitoring circulating epithelial tumour cells (CETC) to gauge therapy: in patients with disease progression after trastuzumab persisting CETC can be eliminated by combined lapatinib treatment

Oumar Camara et al. J Cancer Res Clin Oncol. 2009 Apr.

Abstract

Background: In breast cancers, the gene for the growth factor receptor HER2 can be amplified leading to increased aggressiveness and metastasis formation. The monoclonal antibody trastuzumab prolongs relapse-free survival highly significantly but eventually many patients relapse.

Method: In this study, CETC were monitored using the Maintrac method during adjuvant trastuzumab treatment and during subsequent treatment with capecitabine/lapatinib.

Results: In one patient, trastuzumab led to marginal reduction in CETC with disease progress. The combination of capecitabine/lapatinib was preliminarily capable to eliminate all CETC, however, CETC reappeared. The second patient received adjuvant taxane together with trastuzumab and 1 year of further trastuzumab during which CETC increased. After stopping trastuzumab skin metastases occurred. Capecitabine/lapatinib led to complete CETC elimination with stable disease.

Conclusions: In patients with lack of CETC reduction in spite of trastuzumab treatment correlated with disease progression the combination of capecitabine/lapatinib highly efficiently led to rapid elimination of CETC warranting further monitoring during such studies.

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Figures

Fig. 1
Fig. 1
Typical epithelial antigen positive cells with green caps among blood leucocytes stained orange for CD45 (250× magnification)
Fig. 2
Fig. 2
Response of CETC from the first patient to therapy: minor decrease in CETC during subsequent trastuzumab therapy with concomitant development of further metastases and a rapid but short lasting decrease of CETC numbers during combined lapatinib and capecitabine therapy
Fig. 3
Fig. 3
Response of CETC from the second patient to therapy: increase in CETC during subsequent trastuzumab therapy with development of local relapse treated with mastectomy and a minor decrease during additional trastuzumab therapy with development of skin metastases. After surgery of the skin metastases rapid decrease of CETC numbers during combined lapatinib and capecitabine therapy occurs
See this image and copyright information in PMC

References

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