title: Circulating tumor cells and brain metastasis outcome in patients with HER2-positive breast cancer: the LANDSCAPE trial.
abstract: BACKGROUND
  Decrease of circulating tumor cells (CTC) during treatment is an independent prognostic factor in metastatic breast cancer (MBC). We specifically evaluated the impact of CTC on brain metastasis outcome.
  
  
  METHODS
  HER2-positive MBC with brain metastasis not previously treated with whole-brain radiotherapy received first-line combination of lapatinib and capecitabine in a phase II study. CTC were detected at baseline and day 21 (CellSearch).
  
  
  RESULTS
  Median follow-up of the 44 analyzed patients was 21.2 months. The central nervous system objective response (CNS-OR) rate was 66%. At baseline, 20 of 41 assessable patients for CTC (49%) had ≥1 CTC (range 1-301, median 3) and 9 (22%) had ≥5 CTC. At day 21, 7 of 38 patients (18%) had ≥1 CTC (P = 0.006, versus baseline), and CTC had disappeared in 11 patients. CNS-OR rate was significantly higher in patients with no CTC at day 21 [25 of 31 (80%) versus 2 of 7 (29%), P = 0.01]. The 1-year overall survival rate was 83.9% in patients with no CTC at day 21 versus 42.9% in patients with ≥1 CTC (P = 0.02).
  
  
  CONCLUSIONS
  This is the first report showing a correlation between CNS metastasis response, outcome and early CTC clearance under targeted treatment of HER2+ MBC.
  
  
  BACKGROUND
  NCT00967031.
authors.affiliation: Department of Medical Oncology, Institut Curie and Université Paris Descartes, Paris.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Pierga
authors.forename: F-C
authors.initials: FC
authors.lastname: Bidard
authors.forename: C
authors.initials: C
authors.lastname: Cropet
authors.forename: P
authors.initials: P
authors.lastname: Tresca
authors.forename: F
authors.initials: F
authors.lastname: Dalenc
authors.forename: G
authors.initials: G
authors.lastname: Romieu
authors.forename: M
authors.initials: M
authors.lastname: Campone
authors.forename: C
authors.initials: C
authors.lastname: Mahier Aït-Oukhatar
authors.forename: E
authors.initials: E
authors.lastname: Le Rhun
authors.forename: A
authors.initials: A
authors.lastname: Gonçalves
authors.forename: M
authors.initials: M
authors.lastname: Leheurteur
authors.forename: J
authors.initials: J
authors.lastname: Dômont
authors.forename: M
authors.initials: M
authors.lastname: Gutierrez
authors.forename: H
authors.initials: H
authors.lastname: Curé
authors.forename: J-M
authors.initials: JM
authors.lastname: Ferrero
authors.forename: C
authors.initials: C
authors.lastname: Labbe-Devilliers
authors.forename: T
authors.initials: T
authors.lastname: Bachelot
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D000069287:Capecitabine; D059248:Chemoradiotherapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D053208:Kaplan-Meier Estimate; D000077341:Lapatinib; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000378:metabolism; D011379:Prognosis; D011799:Quinazolines / Q000008:administration & dosage; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D000069287:Capecitabine; D003841:Deoxycytidine; D005472:Fluorouracil; D000077341:Lapatinib; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: HER2; brain metastasis; breast cancer; capecitabine; circulating tumor cells; lapatinib