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肺癌看數據

1.7) 非小細胞肺癌數據 -  CTC上升比PET/CT早半年顯示復發

  

之前提及的臨床證據顯示CTC反映病情, CTC數目的上升反映病情惡化, 但實際應用上, CTC能否比傳統影像檢測更早發現復發呢?

 

美國德州The University of Texas MD Anderson Cancer Center一項前瞻性臨床試驗。研究分析了49名正準備接受電療和化療的患者(Stage II-III的非小細胞肺癌), 跟蹤了他們治療前, 治療中(第2,4,6星期), 治療後(第1,3,6,12,18,24個月) 的CTC數目上升, 希望了解CTC數目的上升能否比起每隔三個月的影像檢測(CT, PET/CT) 更早發現癌症復發。結果發現: 在20名治療後復發的病人中, 有75%(15/20名)的患者CTC數目在治療後上升, 而在這十五名CTC數目上升的患者中, 67% (10/15名)的患者CTC數目上升比影像檢測早六個月(182 days)出現。這個臨床數據顯示,  CTC數目上升可以幫助67%有復發的病人及早發現癌症復發及悪化, 從而及早跟進。

 

 

CTC數目的上升和下降和患者的存活期有什麼關係?

 

英國Paterson Institute for Cancer Research 臨床研究 分析了18名Stage III-IV肺癌患者(非小細胞肺癌)在化療前後的CTC數目, 如果患者不幸CTC數目上升, 總生存期中位數只有3.3個月, 相反若患者的CTC數目下降, 總生存期中位數會有8.3個月(p<0.009)。數據顯示CTC數量的趨勢能幫助患者預測療效

以下是更多的肺癌CTC文獻:

*無進展存活期 = PFS

*無病存活期 = DFS

*總存活期 = OS 

References

  1. Frequency of Circulating Tumor Cells (CTC) in Patients with Brain Metastases: Implications as a Risk Assessment Marker in Oligo-Metastatic Disease.Cancers (Basel). 2018 Dec 19;10(12). pii: E527. doi: 10.3390/cancers10120527.

  2. Evaluation of circulating tumor cells and circulating tumor DNA in non-small cell lung cancer: association with clinical endpoints in a phase II clinical trial of pertuzumab and erlotinib.Clin Cancer Res. 2012 Apr 15;18(8):2391-401. doi: 10.1158/1078-0432.CCR-11-3148. Epub 2012 Apr 5.

  3. Evaluation of circulating tumor cells and related events as prognostic factors and surrogate biomarkers in advanced NSCLC patients receiving first-line systemic treatment. Cancers (2014) 6:153–65. doi: 10.3390/cancers6010153

  4. Circulating tumor cell counts/change for outcome prediction in patients with extensive-stage small- cell lung cancer. Future Oncol. (2016) 12:789–99. doi: 10.2217/fon.15.346

  5. The role of circulating tumor cells in evaluation of prognosis and treatment response in advanced non- small-cell lung cancer. Cancer Chemother Pharmacol. (2017) 79:825–33. doi: 10.1007/s00280-017-3269-x

  6. Prognostic and predictive value of circulating tumor cells and CXCR4 expression as biomarkers for a CXCR4 peptide antagonist in combination with carboplatin-etoposide in small cell lung cancer: exploratory analysis of a phase II study. Invest New Drugs (2017) 35:334–44. doi: 10.1007/s10637-017-0446-z

  7. Prognostic significance of circulating tumor cells in non-small cell lung cancer patients undergoing chemotherapy. Oncotarget (2017) 8:86615–24. doi: 10.18632/oncotarget.21255

  8. Clinical significance of circulating tumor cells in patients with small-cell lung cancer. Tumori J. (2017) 103:242– 8. doi: 10.5301/tj.5000601

  9. Circulating tumor cells predict prognosis following tyrosine kinase inhibitor treatment in EGFR-mutant non-small cell lung cancer patients. Oncol Res. (2017) 25:1601–6. doi: 10.3727/096504017X149286344 01178

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