Circulating tumor cells versus imaging - Predicting overall survival in metastatic breast cancer

G.T. Budd, M. Cristofanilli, M.J. Ellis, A. Stopeck, E. Borden, M.C. Miller, J. Matera, M. Repollet, G.V. Doyle, L.W.M.M. Terstappen, D.F. Hayes

Research output: Contribution to journalArticleAcademicpeer-review

659 Citations (Scopus)


Purpose: The presence of ≥5 circulating tumor cells (CTC) in 7.5 mL blood from patients with measurable metastatic breast cancer before and/or after initiation of therapy is associated with shorter progression-free and overall survival. In this report, we compared the use of CTCs to radiology for prediction of overall survival.

Experimental Design: One hundred thirty-eight metastatic breast cancer patients had imaging studies done before and a median of 10 weeks after the initiation of therapy. All scans were centrally reviewed by two independent radiologists using WHO criteria to determine radiologic response. CTC counts were determined ∼4 weeks after initiation of therapy. Specimens were analyzed at one of seven laboratories and reviewed by a central laboratory.

Results: Interreader variability for radiologic responses and CTC counts were 15.2% and 0.7%, respectively. The median overall survival of 13 (9%) patients with radiologic nonprogression and ≥5 CTCs was significantly shorter than that of the 83 (60%) patients with radiologic nonprogression and
Conclusions: Assessment of CTCs is an earlier, more reproducible indication of disease status than current imaging methods. CTCs may be a superior surrogate end point, as they are highly reproducible and correlate better with overall survival than do changes determined by traditional radiology.
Original languageEnglish
Pages (from-to)6403-6409
JournalClinical cancer research
Issue number21
Publication statusPublished - 2006
Externally publishedYes


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