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BCC 2021 | Circulating tumor cell count-driven vs clinician-driven 1L therapy in HR+, HER2- breast cancer

Jean-Yves Pierga, MD, PhD, Institut Curie, Paris, France, outlines the results of a Phase III trial comparing the efficacy of a clinician-driven treatment choice versus a circulating tumor cell-count (CTC)-driven choice for first-line treatment of patients with hormone receptor-positive (HR+) HER2-negative breast cancer. The findings from this randomized clinical trial demonstrate that CTC count may be a reliable biomarker for guiding the choice between chemotherapy and endocrine therapy in HR+, HER2-negative breast cancer. This interview took place during the 17th St. Gallen International Breast Cancer Conference.

Transcript (edited for clarity)

This trial was to evaluate the interest of using circulating tumor cell detection and level of the circulating tumor cell in a first-line metastatic hormone receptor-positive, HER2-negative metastatic breast cancer patient. And the idea that this has been clearly demonstrated, and the level of evidence is really high, that the level and the detection of CTC is clearly related to the prognostic of a patient...

This trial was to evaluate the interest of using circulating tumor cell detection and level of the circulating tumor cell in a first-line metastatic hormone receptor-positive, HER2-negative metastatic breast cancer patient. And the idea that this has been clearly demonstrated, and the level of evidence is really high, that the level and the detection of CTC is clearly related to the prognostic of a patient. So the idea was to use this information to help the decision between starting the treatment with a hormonal treatment in first line or a chemotherapy in first line for this patient.

It was a randomized trial on nearly 800 patients and this trial has shown that basing the decision on just clinical feeling and the experience of the physician taking care of the patient, or just based on their level of CTC, gives the same result in terms of overall survival and progression-free survival for the patients. So that was one interest of this clinical trial. But also we have shown that for patients who had a high level of CTCs, starting with chemotherapy rather than hormonal treatment could give an advantage in terms of progression-free survival. And so it was a good trend also for overall survival for this patient.

However, these results were interesting in general, but now the strategy for this patient has changed and the hormonal treatment is not given alone. And so standard of treatment integrate clearly now the use of CDK inhibitors. So would the results have been the same, now integrating the CDK inhibitors? That was the main question. And so there is currently a clinical trial in France integrating also CTC level in a clinical trial randomizing a CDK inhibitor plus endocrine treatment versus chemotherapy in first line with patients with aggressive metastatic disease, HER2-negative and hormonal receptor-positive metastatic breast cancer. So we’ll see if this trial validates also the information given by CTCs.

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