Three-year Research Project: Circulating Tumour Cells in Women with Operable Breast Cancer

Project location: ITALY, Milan
Project start date: July 2009 - Project end date: December 2011
Project number: 2009-13

Timeline of the present activity report: From 01/01/2009 to 31/12/2009

Circulating tumor cells in patients with operable breast tumor

Dr. Maria Teresa Sandri
Laboratoy Medicine Unit - Director
Istituto Europeo di Oncologia

Scientific Report - Year 1
(01/01/2009 - 31/12/2009)

Nowadays the majority of cases of death for cancer are due to drug-resistance and metastatisation of the disease.
This last process is caused by the onset of circulating tumor cells (CTC) released by the primary tumor. These cells may colonize new organs and generate untreatable drug-resistant metastases. CTCs are therefore mandatory for the development of metastases, although the progression from single CTC to incurable metastasis may require a support action from the surrounding tissues.
Without such signals, some CTCs might in fact remain dormant for several years after the treatment of the primary tumor.
Thanks to a series of procedures, CTCs can now be isolated from the patients' peripheral blood, but in many cases their predictive/prognostic potential is far from being thoroughly known (carcinoma of the breast included).
To date, available data indicate that the finding of CTC cells in advanced breast cancer patients identifies a population of women with a worst prognosis.
Aim of our research was the evaluation of the prognostic impact of CTC findings in patients affected by operable breast tumor.
We analyzed a first set of 50 patients: in 30% of patients we identified the presence of at least one CTC in 23ml of blood, in the samples drawn before surgery, at 5 days after surgery and, if available, at 30 days post surgery. The presence of CTC does not appear to be related to any of the different characteristics found in the tumor tissue, with the exception of a correlation found with the presence of vascular invasion. Patients will be monitorised in time in order to evaluate the impact of peri-operative CTC findings on the clinical outcome.
Considering the need of new dedicated tools to ease the appropriate management of patients with specific therapies, we thought it would be appropriate to evaluate also those patients that are submitted to primary or neo-adjuvant therapy prior to surgery. Such patients have a locally advanced disease, though not metastatic, and are therefore potentially curable.
The response to therapy might range from complete to non-responsive and, considering the pathologic characteristics of the excised tumor, some women will continue the treatment after surgery with an adjuvant therapy.
It is therefore important to be able to investigate the prognostic and predictive impact of response to therapy of the finding of CTC in this group of women, where the evaluation will be carried out both immediately before surgery and prior to primary therapy.
Our goal is always to evaluate the prevalence of CTC in this group of women, to verify both the presence of correlations with the anatomical-pathological characteristics and the association with possible outcome markers, such as time to onset of recurrence or survival rate.
Our study will be thus more complete as we will have information at different stages of the disease, always in patients candidate to surgery.

Figure 1 highlighted in orange the circulating tumor cells

Figure 2 highlighted in orange the circulating tumor cells


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