Highlights
- •Circulating tumour cells (CTCs) count at baseline and day 28 is a strong prognostic factor in advanced gastric cancer.
- •CTC count at day 28 is also predictive of disease control.
- •Therefore, evolution of CTC count between baseline and D28 could help to early adjust treatment.
Abstract
Background
The identification of dynamic biomarkers in advanced gastric and oesogastric junction
adenocarcinoma (GOA) could help to tailor strategies for each patient. Enumeration
of circulating tumour cells (CTCs) is approved by the US Food and Drug Administration
in breast, colon and prostate cancer but is not in advanced GOA. Our study aims to
establish the optimal threshold and the clinical significance of CTC count in advanced
GOA before and during treatment.
Methods
One hundred six patients with untreated advanced GOA were included in the ancillary
study of the PRODIGE 17-ACCORD 20 trial. CTCs were detected in the peripheral blood
using the CellSearch system on day 0 (D0) and day 28 (D28). The prognostic value of
CTCs at D0 and D28 was analysed by testing several thresholds.
Results
At baseline, median CTC count was 1 (range, 0–415). While CTCs ≥1, 2 or 3 at D0 were
all significantly associated with worse overall survival (OS) and progression-free
survival (PFS), CTCs ≥2 were the optimal threshold, on D0 or D28. CTCs ≥2 at D28 were
also predictive of disease control. Taking into account both D0 and D28 CTC count
defined 3 groups (low/low, high/low and low-high/high) with significantly different
PFS (p = 0.0002) and OS (p = 0.003).
Conclusion
Quantification of CTCs at baseline and during treatment may be a useful prognostic
tool in advanced GOA, as it is associated with worse PFS and OS. A threshold ≥2 CTCs
seems to have the best discriminant value. Change in CTC count between baseline and
D28 could help to tailor treatment to each individual patient.
Keywords
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Article info
Publication history
Published online: April 26, 2017
Accepted:
March 28,
2017
Received in revised form:
March 22,
2017
Received:
February 22,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
