title: Prevalence of Circulating Tumor Cells After Adjuvant Chemotherapy With or Without Anthracyclines in Patients With HER2-negative, Hormone Receptor-positive Early Breast Cancer.
abstract: Use of anthracycline-based chemotherapy in patients with early breast cancer (EBC) has been well-established but is often associated with cardiotoxicity. Based on data suggesting a limited benefit of anthracyclines in human epidermal growth factor receptor 2 (HER2)-negative patients, the Simultaneous Study of Docetaxel Based Anthracycline Free Adjuvant Treatment Evaluation, as well as Life Style Intervention Strategies (SUCCESS) C study randomized patients to either anthracycline-containing or anthracycline-free chemotherapy. Given the proven prognostic value of circulating tumor cells (CTCs) in EBC, we compared the prevalence of CTCs after chemotherapy between both treatment arms for a preliminary efficacy assessment.
  
  
  
  The SUCCESS C trial (NCT00847444) is an open-label, phase III study randomizing 3547 patients with HER2-negative EBC to either 3 cycles of epirubicin, 5-fluorouracil, and cyclophosphamide followed by 3 cycles of docetaxel (FEC-DOC) or 6 cycles of docetaxel and cyclophosphamide (DOC-C). CTC status was prospectively evaluated in hormone receptor-positive patients at the time of last chemotherapy cycle using the US Food and Drug Administration-approved CellSearch System (Janssen Diagnostics).
  
  
  
  Data on CTC status were available for 1766 patients. Overall, CTCs were found in 221 (12.5%) patients. Univariate analyses revealed that presence of CTCs at time of last chemotherapy cycle was not significantly associated with tumor or patient characteristics (all P > .1). There was no significant difference with respect to presence of CTCs between patients randomized to FEC-DOC or DOC-C (11.5% vs. 13.6%; P = .18).
  
  
  
  The comparable prevalence of CTCs at the time of last chemotherapy cycle may indicate that anthracycline-free chemotherapy is equally effective to anthracycline-containing chemotherapy in HER2-negative, hormone receptor-positive EBC. However, efficacy data from the final survival analysis of SUCCESS C have to be awaited to confirm these preliminary findings.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany. Electronic address: Amelie.Schramm@uniklinik-ulm.de.
authors.forename: Amelie
authors.initials: A
authors.lastname: Schramm
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Schochter
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Thomas W P
authors.initials: TWP
authors.lastname: Friedl
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: de Gregorio
authors.affiliation: Department of Obstetrics and Gynecology, Ludwig Maximilians University, Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Andergassen
authors.affiliation: Department of Obstetrics and Gynecology, Ludwig Maximilians University, Munich, Germany.
authors.forename: Marianna
authors.initials: M
authors.lastname: Alunni-Fabbroni
authors.affiliation: Department of Obstetrics and Gynecology, Ludwig Maximilians University, Munich, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Trapp
authors.affiliation: Department of Obstetrics and Gynecology, Heinrich Heine University, Duesseldorf, Germany.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Jaeger
authors.affiliation: Medical Office of Gynecology, Fürstenwalde, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Heinrich
authors.affiliation: Department of Obstetrics and Gynecology, Hufeland Hospital, Bad Langensalza, Germany.
authors.forename: Oumar
authors.initials: O
authors.lastname: Camara
authors.affiliation: Medical Office of Oncology, Ravensburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Decker
authors.affiliation: Department of Gynecology, St Vincenz Hospital Limburg, Limburg, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Ober
authors.affiliation: Department of Obstetrics and Gynecology, Ludwig Maximilians University, Munich, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
authors.affiliation: Department of Obstetrics and Gynecology, Heinrich Heine University, Duesseldorf, Germany.
authors.forename: Tanja N
authors.initials: TN
authors.lastname: Fehm
authors.affiliation: Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Pantel
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Fasching
authors.affiliation: National Center for Tumor Diseases, Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.affiliation: Department of Obstetrics and Gynecology, Ludwig Maximilians University, Munich, Germany.
authors.forename: Brigitte K
authors.initials: BK
authors.lastname: Rack
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D015995:Prevalence; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D014408:Biomarkers, Tumor; D003520:Cyclophosphamide; D000077143:Docetaxel; D015251:Epirubicin; D005472:Fluorouracil; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D043823:Taxoids; C508053:ERBB2 protein, human
keywords: Adjuvant chemotherapy; Anthracyclines; Circulating tumor cells; HER2-negative early breast cancer