Circulating Tumor Cells in Early Breast Cancer

Abstract

Circulating tumor cells (CTCs) are particularly rare in non-metastatic breast cancer, and the clinical validity of CTC detection in that clinical setting was initially not well recognized. A cytological CTC detection device (CellSearch) fulfilling the CLIA requirements for analytical validity was subsequently developed and, in 2008, we reported the first study (REMAGUS02) showing that distant metastasis-free survival was shorter in early breast cancer patients with one or more CTCs. In the past 10 years, other clinical studies and meta-analyses have established CTC detection as a level-of-evidence 1 prognostic biomarker for local relapses, distant relapses, and overall survival. This review summarizes available data on CTC detection and the promises of this proliferation- and subtype-independent metastasis-associated biomarker in early breast cancer patients.

Figure 1.

Positivity rate of a second circulating tumor cell CTC) count according to the first CTC count. This graph displays the probability of (Y2) being above the cut-off (CTCs = 1) as a function of a prior CTC count (Y1), in the absence of any efficient therapeutic intervention.