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

G. Thomas Budd, Massimo Cristofanilli, Mathew J. Ellis, Allison Stopeck, Ernest Borden, M. Craig Miller, Jeri Matera, Madeline Repollet, Gerald V. Doyle, Leon W.M.M. Terstappen, Daniel F. Hayes

Research output: Contribution to journalArticlepeer-review

672 Scopus citations


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 non-progression and <5 CTCs (15.3 versus 26.9 months; P = 0.0389). The median overall survival of the 20 (14%) patients with radiologic progression and <5 CTCs was significantly longer than the 22 (16%) patients with ≥5 CTCs that showed progression by radiology (19.9 versus 6.4 months; P = 0.0039). 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 (US)
Pages (from-to)6403-6409
Number of pages7
JournalClinical Cancer Research
Issue number21
StatePublished - Nov 1 2006

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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