Circulating tumor cells dynamics during chemotherapy predict survival and response in advanced non-small-cell lung cancer patients

BACKGROUND: Circulating tumor cells (CTCs) are prognostic biomarker in non-small-cell lung cancer (NSCLC). CTCs could also be used as predictor of efficacy of systemic treatments in advanced NSCLC. OBJECTIVES: We described the dynamic changes of CTCs during first-line platinum-based chemotherapy in advanced NSCLC and clarified the correlation between CTC counts and efficacy of chemotherapy. DESIGN: Chemotherapy is administered and blood specimens are collected at four time points from baseline to disease progression for CTC detection. METHODS: This multicenter prospective study enrolled patients with previously untreated stage III or IV NSCLC fit for standard platinum-based chemotherapy. Bloods were sampled as per standard operating procedures at baseline, cycle 1 and cycle 4 of chemotherapy, and at disease progression for CTC analysis using the CellSearch system. RESULTS: Among 150 patients enrolled, median overall survival (OS) was 13.8, 8.4, and 7.9 months in patients with CTC(−), KIT(−)CTC, and KIT(+)CTC at baseline (p = 0.002). Patients with persistent negative CTC (46.0%) had longer progression-free survival [5.7 months, 95% confidence interval (CI): 5.0–6.5 versus 3.0 months, 0.6–5.4; hazard ratio (HR): 0.34, 95% CI: 0.18–0.67) and OS (13.1 months, 10.9–15.3 versus 5.6 months, 4.1–7.1; HR: 0.17, 0.08–0.36) compared with patients with persistent positive CTC (10.7%), which was not impacted by chemotherapy. Chemotherapy decreased CTC from 36.0% (54/150) to 13.7% (13/95). CONCLUSIONS: CTC persistent presence during treatment represents poor prognosis and resistance to chemotherapy in advanced NSCLC. Chemotherapy could effectively eliminate CTCs. Molecular characterization and the functionalization of CTC will be warranted for further intensive investigation. TRIAL REGISTRATION: NCT01740804.