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

Abstract

Background In breast cancers, the gene for the growth factor receptor HER2 can be ampliWed leading to increased aggressiveness and metastasis formation. The monoclonal antibody trastuzumab prolongs relapse-free survival highly signiWcantly 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.

Detection of EpCAM-Negative and Cytokeratin-Negative Circulating Tumor Cells in Peripheral Blood

“…Other emerging approaches do not depend on immuoenrichment at all but instead use precise size filters to separate larger epithelial cells from smaller red blood cells (RBCs) and white blood cells (WBCs) [8]. Alternatively, approaches using only cell lysis to remove interfering RBC have been described [9, 10]. In this case all remaining nucleated cells remaining after RBC lysis are layered onto several slides for further analysis.…”

“…Counterstaining with anti-CD45 is employed to rule out occasional nucleated WBC that stain for CK. In those cases where EpCAM has not been used for enrichment, such as the RBC lysis approach, EpCAM can alternatively be used for detection [10, 14]. PCR-based approaches generally use some combination of anti-EpCAM or anti-CK for enrichment or detection before DNA is extracted for analysis [12, 15, 16].…”

Circulating tumor cells and emerging blood biomarkers in breast cancer

“…In a case report, Camara et al [32] monitored CTCs by MAINTRAC in two patients with MBC treated by lapatinib-based regimen after progression on trastuzumab. More data are needed for the value of MAINTRAC technology to monitor MBC patients treated with anti-HER2 agents.…”

Detection of Circulating Tumor Cells in Breast Cancer Patients: Prognostic Predictive Role

“…Other ongoing trials STIC CTC METABREAST (France) and Endocrine Therapy Index (USA) assess the CTC guided hormone therapy vs. chemotherapy decision in M1 patients (Bidard et al, 2012). In two metastatic breast carcinoma cases, early changing to capecitabine plus lapatinib treatment after detection of doubling of CTC numbers on treatment resulted in near total decrease in CTC numbers (Camara et al, 2009). Ongoing trials DETECT III (M1 patients, Germany) and Treat CTC (cM0(i+)patients, European Organisation for Research and Treatment of Cancer/ Breast International Group) assess the use of anti-HER2 treatments in HER2-negative breast cancer patients selected on the basis of CTC charactersitics (Bidard et al, 2012).…”