Carolyn S Hall1, Merrick Ross2, Jessica B Bowman Bauldry1, Joshua Upshaw1, Mandar G Karhade1, Richard Royal2, Sapna Patel3, Anthony Lucci4. 1. Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. 2. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. 3. Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. 4. Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: alucci@mdanderson.org.
Abstract
BACKGROUND: Management of stage IV melanoma patients remains a challenge. In spite of promising new therapies, many patients develop resistance and progression. The aim of this pilot study was to determine if circulating tumor cells (CTCs) are associated with shortened (180-day) progression-free survival (PFS) after a baseline CTC assessment in stage IV melanoma patients. STUDY DESIGN: A baseline CTC assessment was performed in 93 stage IV melanoma patients using a commercially available immunomagnetic system. The presence of 1 or more CTC was considered a positive result. A Cox multivariable regression model was used to evaluate the association between presence of CTCs at baseline and PFS, after adjusting for covariables. Kaplan-Meier curves and a log-rank test were used to summarize and compare unadjusted PFS for patients stratified by CTC positivity. RESULTS: Median follow-up was 17 months; mean age was 55 years. Thirteen of 93 (14%) patients had no evidence of disease (NED) at baseline CTC assessment. One or more CTC was detected in 39 of 93 (42%) of patients at baseline; CTCs were not associated with primary melanoma features or NED status. Twenty-eight of 93 (30%) patients progressed within 180 days of baseline draw, with 20 of 39 (51%) of the CTC-positive patients relapsing compared with 8 of 54 (15%) of the CTC-negative patients. In adjusted Cox models, a significant association was found suggesting worse PFS within 180 days for CTC-positive patients at baseline (vs CTC-negative) (hazard ratio 4.69, 95% CI 1.59 to 13.77, p = 0.005). CONCLUSIONS: One or more CTCs at baseline were associated with progression within 180 days in stage IV melanoma patients. This information warrants further study of CTCs as a means of identifying patients at high-risk for disease progression.
BACKGROUND: Management of stage IV melanomapatients remains a challenge. In spite of promising new therapies, many patients develop resistance and progression. The aim of this pilot study was to determine if circulating tumor cells (CTCs) are associated with shortened (180-day) progression-free survival (PFS) after a baseline CTC assessment in stage IV melanomapatients. STUDY DESIGN: A baseline CTC assessment was performed in 93 stage IV melanomapatients using a commercially available immunomagnetic system. The presence of 1 or more CTC was considered a positive result. A Cox multivariable regression model was used to evaluate the association between presence of CTCs at baseline and PFS, after adjusting for covariables. Kaplan-Meier curves and a log-rank test were used to summarize and compare unadjusted PFS for patients stratified by CTC positivity. RESULTS: Median follow-up was 17 months; mean age was 55 years. Thirteen of 93 (14%) patients had no evidence of disease (NED) at baseline CTC assessment. One or more CTC was detected in 39 of 93 (42%) of patients at baseline; CTCs were not associated with primary melanoma features or NED status. Twenty-eight of 93 (30%) patients progressed within 180 days of baseline draw, with 20 of 39 (51%) of the CTC-positive patients relapsing compared with 8 of 54 (15%) of the CTC-negative patients. In adjusted Cox models, a significant association was found suggesting worse PFS within 180 days for CTC-positive patients at baseline (vs CTC-negative) (hazard ratio 4.69, 95% CI 1.59 to 13.77, p = 0.005). CONCLUSIONS: One or more CTCs at baseline were associated with progression within 180 days in stage IV melanomapatients. This information warrants further study of CTCs as a means of identifying patients at high-risk for disease progression.
Authors: Michael G White; Andrew Lee; Diego Vicente; Carolyn Hall; Michael P Kim; Matthew H G Katz; Jeffrey E Lee; Naruhiko Ikoma; Anthony Lucci; Ching-Wei D Tzeng Journal: Ann Surg Oncol Date: 2021-01-07 Impact factor: 4.339
Authors: Joseph W Po; Yafeng Ma; Bavanthi Balakrishna; Daniel Brungs; Farhad Azimi; Paul de Souza; Therese M Becker Journal: PLoS One Date: 2019-02-08 Impact factor: 3.240