Anthony Lucci, MD
A study published by Anthony Lucci, MD, and colleagues in Clinical Cancer Research showed that the presence of circulating tumor cells was independently associated with relapse of melanoma, suggesting circulating tumor cell assessment may be a useful tool for identifying patients at risk for relapse who may benefit from adjuvant therapy.
Study Background
Although circulating tumor cells can be detected in patients with melanoma, there are limited data regarding their significance in stage III, or node-positive, disease. This prospective study was based on earlier research that found circulating tumor cells in a significant number of patients with breast cancer. In that study, circulating tumor cells were associated with relapse, independent of other existing methods for determining prognosis.
“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,” said Dr. Lucci, Professor of Breast Surgical Oncology and Surgical Oncology at The University of Texas MD Anderson Cancer Center. “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.”
Methods and Results
The researchers assessed circulating tumor cells during the patient’s first clinic visit, and relapse-free survival was compared between patients with one or more circulating tumor cells vs those with no circulating tumor cells. Circulating tumor cells were observed in 90 out of 243 patients enrolled in the study (37%).
“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.... [T]he 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.”— Anthony Lucci, MD
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“Our analysis demonstrated that detection [of one or more circulating tumor cell] was significantly associated with a decrease in relapse-free survival at 6 months, and persisted at a 54-month longer-term follow-up,” said Dr. Lucci. “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.”
In a statement, Dr. Lucci added that this this new method is needed, given that there currently is no clear consensus on when to recommend immunotherapy for patients with node-positive melanoma. Despite the development of new targeted and immunotherapies for melanoma, many patients either do not respond to these therapies or develop resistance to therapy within 6 to 8 months. Such therapies may also produce side effects in patients, so avoiding treatment in those at low risk for relapse may prevent overtreatment.
The study authors concluded, “One or more circulating tumor cell was independently associated with melanoma relapse, suggesting that circulating tumor cell assessment may be useful to identify patients at risk for relapse who could derive benefit from adjuvant therapy.”
Disclosure: The study was funded by Sheila Prenowitz, Debbie and Craig Kiefer, the Simon and Linda Eyles Foundation, the Sam and Janna Moore family, and the Wintermann Foundation. For full disclosures of the study authors, visit clincancerres.aacrjournals.org.
