High number of tumour cells may affect breast cancer outcomes
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《英国医生杂志》
Women with advanced breast cancer who have five or more tumour cells circulating in their blood die sooner than women with fewer such cells, says a new study in the New England Journal of Medicine (2004;351:781-91).
The study could lead to more tailored treatments that would spare some women the most potent chemotherapy, or conversely, recognise at the start of treatment which patients need more aggressive therapy, says lead author Massimo Cristofanilli, associate professor in the breast medical oncology department at the University of Texas MD Anderson Cancer Center.
"This is the first time we can actually stratify metastatic breast cancer patients based on their risk," he says. "Now we may know more about what the prognosis will be, based on a simple blood test and a new technology." The prospective multicentre trial was conducted at 20 institutions in the United States. A total of 117 women with advanced breast cancer were enrolled.
Overall, survival in the women with more than five circulating tumour cells was 8.2 months, compared with more than 18 months in the cohort with fewer than five circulating tumour cells.
A Canadian study supports the concept that circulating tumour cells can be detected and counted in the peripheral blood and says that "this minimally invasive assay merits further evaluation as a potential prognostic indicator and marker of disease progression" (Breast Cancer Research and Treatment 2004;86:237-47).
Dr Maureen Trudeau, head of medical oncology and haematology and coauthor of the Canadian study, emphasised that researchers are still searching for the significance of these circulating cells. However, she was quoted in the Toronto newspaper the Globe and Mail as saying that the Canadians have managed to detect tumour cells in the bloodstream of women even before their breast cancer appeared to have spread.
The newspaper also reported that at Toronto抯 Sunnybrook and Women抯 College Health Sciences Centre researchers are testing the blood of women who have a genetic risk of breast cancer yet have no signs of the disease. They hope that by using such methods, a test might be developed one day for use in a screening programme that could detect cancer in its earliest stages.
Until recently, circulating tumour cells could not be isolated in the blood reliably. In the past few years, several methods have been developed to label tumour cells with antibodies that can then be measured precisely, identifying even one tumour cell in a vial of blood.
The diagnostic technology used in the US study, the CellSearch(tm) System, is marketed by Veridex, LLC, a Johnson and Johnson company, and works by detecting cancer cells that detach from solid tumours and enter the blood stream. The test is expected to become commercially available this autumn.
The Canadian method of drawing out tumour cells from the blood uses chemical filtration to eliminate all cells that are not cancerous.
Dr Michael Crump, a medical oncologist at Toronto抯 Princess Margaret Hospital, said that methods and factors other than testing the number of cancer cells in the blood could be just as helpful in evaluating the disease—such as tumour size, the patient抯 age, bone scans, chest x rays, and a list of symptoms compiled by the patient. He maintained that the test, as reported in the US study, is not completely reliable; some patients with high counts of tumour cells in the blood lived beyond the duration of the study, he said.(Quebec David Spurgeon)
The study could lead to more tailored treatments that would spare some women the most potent chemotherapy, or conversely, recognise at the start of treatment which patients need more aggressive therapy, says lead author Massimo Cristofanilli, associate professor in the breast medical oncology department at the University of Texas MD Anderson Cancer Center.
"This is the first time we can actually stratify metastatic breast cancer patients based on their risk," he says. "Now we may know more about what the prognosis will be, based on a simple blood test and a new technology." The prospective multicentre trial was conducted at 20 institutions in the United States. A total of 117 women with advanced breast cancer were enrolled.
Overall, survival in the women with more than five circulating tumour cells was 8.2 months, compared with more than 18 months in the cohort with fewer than five circulating tumour cells.
A Canadian study supports the concept that circulating tumour cells can be detected and counted in the peripheral blood and says that "this minimally invasive assay merits further evaluation as a potential prognostic indicator and marker of disease progression" (Breast Cancer Research and Treatment 2004;86:237-47).
Dr Maureen Trudeau, head of medical oncology and haematology and coauthor of the Canadian study, emphasised that researchers are still searching for the significance of these circulating cells. However, she was quoted in the Toronto newspaper the Globe and Mail as saying that the Canadians have managed to detect tumour cells in the bloodstream of women even before their breast cancer appeared to have spread.
The newspaper also reported that at Toronto抯 Sunnybrook and Women抯 College Health Sciences Centre researchers are testing the blood of women who have a genetic risk of breast cancer yet have no signs of the disease. They hope that by using such methods, a test might be developed one day for use in a screening programme that could detect cancer in its earliest stages.
Until recently, circulating tumour cells could not be isolated in the blood reliably. In the past few years, several methods have been developed to label tumour cells with antibodies that can then be measured precisely, identifying even one tumour cell in a vial of blood.
The diagnostic technology used in the US study, the CellSearch(tm) System, is marketed by Veridex, LLC, a Johnson and Johnson company, and works by detecting cancer cells that detach from solid tumours and enter the blood stream. The test is expected to become commercially available this autumn.
The Canadian method of drawing out tumour cells from the blood uses chemical filtration to eliminate all cells that are not cancerous.
Dr Michael Crump, a medical oncologist at Toronto抯 Princess Margaret Hospital, said that methods and factors other than testing the number of cancer cells in the blood could be just as helpful in evaluating the disease—such as tumour size, the patient抯 age, bone scans, chest x rays, and a list of symptoms compiled by the patient. He maintained that the test, as reported in the US study, is not completely reliable; some patients with high counts of tumour cells in the blood lived beyond the duration of the study, he said.(Quebec David Spurgeon)