title: The relevance of circulating epithelial tumor cells (CETC) for therapy monitoring during neoadjuvant (primary systemic) chemotherapy in breast cancer.
abstract: BACKGROUND
  Having demonstrated in a previous report that the response of circulating epithelial tumor cells (CETC) during the first cycles of primary (neoadjuvant) chemotherapy perfectly reflects the response of the tumor, in the present study the changes in cell numbers during subsequent cycles and their possible impact on the therapy's outcome were examined.
  
  
  METHODS
  In 58 breast cancer patients CETC were quantified during therapy with either EC (epirubicin/ cyclophosphamid) or dose intensified E (epirubicin) followed by taxane, with or without trastuzumab, and subsequent CMF (cyclophosphamid/methorexate/ fluorouracil).
  
  
  RESULTS
  CETC numbers declined more than 10-fold (good response) in 65% (her2/neu-negative) and 55% (her2/neu-positive) of patients during EC, and in 60% during dose intensified E, respectively, followed by an increase of CETC in all patients. CETC remained increased, decreasing only when adding CMF. A good initial response correlated with estrogen-receptor negativity, a poor response with early distant relapse (P < 0,0001, hazard ratio = 11.91).
  
  
  CONCLUSIONS
  Response of CETC already during the first cycles of neoadjuvant treatment predicts the final response of the tumor. Hitherto unknown effects of the release of tumor cells during therapy further our understanding of tumor-blood interaction and may improve access of agents like antibodies to cells. The impact on the further course of disease remains to be evaluated.
authors.affiliation: Women's Hospital, Helios Klinikum Berlin-Buch, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Camara
authors.forename: M
authors.initials: M
authors.lastname: Rengsberger
authors.forename: A
authors.initials: A
authors.lastname: Egbe
authors.forename: A
authors.initials: A
authors.lastname: Koch
authors.forename: M
authors.initials: M
authors.lastname: Gajda
authors.forename: U
authors.initials: U
authors.lastname: Hammer
authors.forename: C
authors.initials: C
authors.lastname: Jörke
authors.forename: C
authors.initials: C
authors.lastname: Rabenstein
authors.forename: M
authors.initials: M
authors.lastname: Untch
authors.forename: K
authors.initials: K
authors.lastname: Pachmann
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000097:blood* / Q000378:metabolism / Q000628:therapy*; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone; D016896:Treatment Outcome
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone