Circulating tumor cells predictive of relapse in stage III melanoma
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Circulating tumor cells appeared independently associated with relapse among patients with stage III melanoma, according to results of a prospective study published in Clinical Cancer Research.
“Our findings are significant, given that there is a need for blood-based biomarkers to guide clinical decision-making for [patients with stage III melanoma],” Anthony Lucci, MD, professor of breast surgical oncology and surgical oncology at The University of Texas MD Anderson Cancer Center, said in a press release. “There currently are no blood tests available to help doctors accurately tell which patients are likely to relapse and should be given therapy, and which are low risk and could be observed.”
Although previous studies have shown the presence of circulating tumor cells may have prognostic value, the various methodologies used and lack of standardization have precluded their use in the clinic as a melanoma biomarker, according to researchers.
Lucci and colleagues used the CellSearch Circulating Melanoma Cell Assay (Menarini Silicon Biosystems) to evaluate the prognostic significance of circulating tumor cell detection among 243 patients (mean age, 57 years; range, 20-88; 61% men) with stage III cutaneous melanoma. Prior studies using this assay included only patients with stage IV melanoma.
The analysis included patients with stage IIIA (n = 45), stage IIIB (n = 67), stage IIIC (n = 118) and stage IIID (n = 13) disease.
Researchers compared RFS among patients with one or more baseline circulating tumor cells (n = 90) and patients with no circulating tumor cells (n = 153).
Median follow-up was 17 months.
Forty-three (48%) of the 90 patients who had one or more circulating tumor cells at baseline relapsed during the follow-up period, compared with 56 (37%) of 153 patients with no circulating tumor cells at baseline.
Multivariable analysis showed significant associations between detection of one or more baseline circulating tumor cells and poorer RFS within 6 months (HR = 3.13; 95% CI, 1.21-8.09) and 54 months (HR = 2.25; 95% CI, 1.25-4.06).
Circulating tumor cells, however, did not appear associated with substage or primary tumor characteristics, including Breslow thickness, Clark’s level, ulceration, mitotic range and BRAF V600E mutation status.
A lack of extensive tumor molecular profiling served as a limitation to this study. Other limitations included a lack of effective checkpoint blockade and targeted therapy regimens employed during the study.
“Our analysis demonstrated that circulating tumor cell detection was significantly associated with a decrease in RFS at 6 months, and persisted at a 54-month longer-term follow-up,” Lucci said. “The data from this study provide support for the future pursuit of liquid biopsy techniques to help identify patients most likely to benefit from adjuvant systemic therapy.” – by John DeRosier
Disclosures: The authors report no relevant financial disclosures.
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