TY - JOUR
T1 - Early Detection of Recurrence in Patients With Locally Advanced Non–Small-Cell Lung Cancer via Circulating Tumor Cell Analysis
AU - Chinniah, Chimbu
AU - Aguarin, Louise
AU - Cheng, Phillip
AU - Decesaris, Cristina
AU - Cutillo, Alicia
AU - Berman, Abigail T.
AU - Frick, Melissa
AU - Doucette, Abigail
AU - Cengel, Keith A.
AU - Levin, William
AU - Hahn, Stephen
AU - Dorsey, J. F.
AU - Simone, Charles B.
AU - Kao, Gary D.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/9
Y1 - 2019/9
N2 - Background: Assays to identify circulating tumor cells (CTCs) might allow for noninvasive and sequential monitoring of lung cancer. We investigated whether serial CTC analysis could complement conventional imaging for detecting recurrences after treatment in patients with locally advanced non–small-cell lung cancer (LA-NSCLC). Patients and Methods: Patients with LA-NSCLC (stage II-III) who definitively received concurrent chemoradiation were prospectively enrolled, with CTCs from peripheral blood samples identified using an adenoviral probe that detects elevated telomerase activity present in nearly all lung cancer cells. A “detectable” CTC level was defined as 1.3 green flourescent protein-positive cells per milliliter of collected blood. Samples were obtained before, during (at weeks 2, 4, and 6), and after treatment (post-radiation therapy [RT]; at months 1, 3, 6, 12, 18, and 24). Results: Forty-eight patients were enrolled. At a median follow-up of 10.9 months, 22 (46%) patients had disease recurrence at a median time of 7.6 months post-RT (range, 1.3-32.0 months). Of the 20 of 22 patients for whom post-RT samples were obtained, 15 (75%) had an increase in CTC counts post-RT. In 10 of these 15 patients, CTCs were undetectable on initial post-RT draw but were then detected again before radiographic detection of recurrence, with a median lead time of 6.2 months and mean lead time of 6.1 months (range, 0.1-12.0 months) between CTC count increase and radiographic evidence of recurrence. One patient with an early recurrence (4.7 months) had persistently elevated detectable CTC levels during and after treatment. Conclusion: These results indicate that longitudinal CTC monitoring in patients with LA-NSCLC treated with chemoradiation is feasible, and that detectable CTC levels in many patients meaningfully precede radiologic evidence of disease recurrence. We investigated the potential usefulness of sequential circulating tumor cell (CTC) analysis for patients treated for locally advanced non–small-cell lung cancer (LA-NSCLC). We found that a CTC level increase gave median and mean lead time notice of progression of disease of approximately 6 months ahead of radiographic evidence. This telomerase-based CTC assay might thus complement conventional imaging for post-treatment monitoring of patients with LA-NSCLC.
AB - Background: Assays to identify circulating tumor cells (CTCs) might allow for noninvasive and sequential monitoring of lung cancer. We investigated whether serial CTC analysis could complement conventional imaging for detecting recurrences after treatment in patients with locally advanced non–small-cell lung cancer (LA-NSCLC). Patients and Methods: Patients with LA-NSCLC (stage II-III) who definitively received concurrent chemoradiation were prospectively enrolled, with CTCs from peripheral blood samples identified using an adenoviral probe that detects elevated telomerase activity present in nearly all lung cancer cells. A “detectable” CTC level was defined as 1.3 green flourescent protein-positive cells per milliliter of collected blood. Samples were obtained before, during (at weeks 2, 4, and 6), and after treatment (post-radiation therapy [RT]; at months 1, 3, 6, 12, 18, and 24). Results: Forty-eight patients were enrolled. At a median follow-up of 10.9 months, 22 (46%) patients had disease recurrence at a median time of 7.6 months post-RT (range, 1.3-32.0 months). Of the 20 of 22 patients for whom post-RT samples were obtained, 15 (75%) had an increase in CTC counts post-RT. In 10 of these 15 patients, CTCs were undetectable on initial post-RT draw but were then detected again before radiographic detection of recurrence, with a median lead time of 6.2 months and mean lead time of 6.1 months (range, 0.1-12.0 months) between CTC count increase and radiographic evidence of recurrence. One patient with an early recurrence (4.7 months) had persistently elevated detectable CTC levels during and after treatment. Conclusion: These results indicate that longitudinal CTC monitoring in patients with LA-NSCLC treated with chemoradiation is feasible, and that detectable CTC levels in many patients meaningfully precede radiologic evidence of disease recurrence. We investigated the potential usefulness of sequential circulating tumor cell (CTC) analysis for patients treated for locally advanced non–small-cell lung cancer (LA-NSCLC). We found that a CTC level increase gave median and mean lead time notice of progression of disease of approximately 6 months ahead of radiographic evidence. This telomerase-based CTC assay might thus complement conventional imaging for post-treatment monitoring of patients with LA-NSCLC.
KW - CTC
KW - LA-NSCLC
KW - Lung cancer
KW - Prospective trial
KW - Radiation oncology
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U2 - 10.1016/j.cllc.2019.04.011
DO - 10.1016/j.cllc.2019.04.011
M3 - Article
C2 - 31221522
AN - SCOPUS:85067307464
SN - 1525-7304
VL - 20
SP - 384-390.e2
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
IS - 5
ER -