CirCe01 trial aimed to assess the clinical utility of circulating tumour cell (CTC)-based monitoring in metastatic breast cancer (MBC) patients beyond the third line of chemotherapy (LC).
CirCe01 was a prospective, multicentre, randomised trial (NCT01349842) that included patients with MBC after two systemic LC. Patients with ≥5 CTC/7.5 mL (CellSearch®) were randomised between the CTC-driven and the standard arm. In the CTC arm, changes in CTC count were assessed at the first cycle of each LC; patients in whom CTC levels predicted early tumour progression had to switch to a subsequent LC.
Greater than or equal to 5 CTC/7.5 mL were observed in N = 101/204 patients. In the CTC arm (N = 51), 43 (83%) and 18 (44%) patients completed CTC monitoring in the third and fourth lines, respectively, and 18 (42%) and 11 (61%) of these patients, respectively, had no CTC response. Thirteen (72%) and 5 (46%) of these patients underwent early switch to the next LC. Overall survival was not different between the two arms (hazard ratio = 0.95, 95% confidence interval = [0.6;1.4], p = 0.8). In subgroup analyses, patients with no CTC response who switched chemotherapy experienced longer survival than patients who did not.
Due to the limited accrual and compliance, this trial failed to demonstrate the clinical utility of CTC monitoring.
Clinical Trial Registration
NCT, NCT01349842, https://clinicaltrials.gov/ct2/show/NCT01349842, registered 9 May 2011.
Subscribe to Journal
Get full journal access for 1 year
only $20.79 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet-Tieulent, J. & Jemal, A. Global cancer statistics, 2012. CA Cancer J. Clin. 65, 87–108 (2015).
Gobbini, E., Ezzalfani, M., Dieras, V., Bachelot, T., Brain, E., Debled, M. et al. Time trends of overall survival among metastatic breast cancer patients in the real-life ESME cohort. Eur. J. Cancer 96, 17–24 (2018).
Cardoso, F., Senkus, E., Costa, A., Papadopoulos, E., Aapro, M., André, F. et al. 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)†. Ann. Oncol. 29, 1634–1657 (2018).
Cortes, J., O’Shaughnessy, J., Loesch, D., Blum, J. L., Vahdat, L. T., Petrakova, K. et al. Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. Lancet 377, 914–923 (2011).
Palumbo, R., Sottotetti, F., Riccardi, A., Teragni, C., Pozzi, E., Quaquarini, E. et al. Which patients with metastatic breast cancer benefit from subsequent lines of treatment? An update for clinicians. Ther. Adv. Med. Oncol. 5, 334–350 (2013).
Planchat, E., Abrial, C., Thivat, E., Mouret-Reynier, M. A., Kwiatkowski, F., Pomel, C. et al. Late lines of treatment benefit survival in metastatic breast cancer in current practice? Breast 20, 574–578 (2011).
Tacca, O., LeHeurteur, M., Durando, X., Mouret-Reynier, M.-A., Abrial, C., Thivat, E. et al. Metastatic breast cancer: overall survival related to successive chemotherapies. What do we gain after the third line? Cancer Invest. 27, 81–85 (2009).
Kassam, F., Enright, K., Dent, R., Dranitsaris, G., Myers, J., Flynn, C. et al. Survival outcomes for patients with metastatic triple-negative breast cancer: implications for clinical practice and trial design. Clin. Breast Cancer 9, 29–33 (2009).
Cabel, L., Proudhon, C., Mariani, P., Tzanis, D., Beinse, G., Bieche, I. et al. Circulating tumor cells and circulating tumor DNA: what surgical oncologists need to know? Eur. J. Surg. Oncol. https://doi.org/10.1016/j.ejso.2017.01.010 (2017).
Cristofanilli, M., Budd, G. T., Ellis, M. J., Stopeck, A., Matera, J., Miller, M. C. et al. Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N. Engl. J. Med. 351, 781–791 (2004).
Hayes, D. F., Cristofanilli, M., Budd, G. T., Ellis, M. J., Stopeck, A., Miller, M. C. et al. Circulating tumor cells at each follow-up time point during therapy of metastatic breast cancer patients predict progression-free and overall survival. Clin. Cancer Res. 12, 4218–4224 (2006).
Bidard, F.-C., Peeters, D. J., Fehm, T., Nolé, F., Gisbert-Criado, R., Mavroudis, D. et al. Clinical validity of circulating tumour cells in patients with metastatic breast cancer: a pooled analysis of individual patient data. Lancet Oncol. 15, 406–414 (2014).
Cristofanilli, M., Pierga, J.-Y., Reuben, J., Rademaker, A., Davis, A. A., Peeters, D. J. et al. The clinical use of circulating tumor cells (CTCs) enumeration for staging of metastatic breast cancer (MBC): International Expert Consensus Paper. Crit. Rev. Oncol. Hematol. 134, 39–45 (2019).
Helissey, C., Berger, F., Cottu, P., Diéras, V., Mignot, L., Servois, V. et al. Circulating tumor cell thresholds and survival scores in advanced metastatic breast cancer: the observational step of the CirCe01 phase III trial. Cancer Lett. 360, 213–218 (2015).
Smerage, J. B., Barlow, W. E., Hortobagyi, G. N., Winer, E. P., Leyland-Jones, B., Srkalovic, G. et al. Circulating tumor cells and response to chemotherapy in metastatic breast cancer: SWOG S0500. J. Clin. Oncol. 32, 3483–3489 (2014).
Bidard, F.-C., Fehm, T., Ignatiadis, M., Smerage, J. B., Alix-Panabières, C., Janni, W. et al. Clinical application of circulating tumor cells in breast cancer: overview of the current interventional trials. Cancer Metastasis Rev. 32, 179–188 (2013).
Bidard, F.-C. & Pierga, J.-Y. Clinical utility of circulating tumor cells in metastatic breast cancer. J. Clin. Oncol. 33, 1622 (2015).
La Ligue Contre le Cancer, the French Ministry of Health and Institut Curie SIRIC2 programme.
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki. This prospective, multicentre, open-label, randomised trial (six centres) was approved by the regional ethics board (Comité de Protection des Personnes—Ile de France) and identified as NCT01349842. All patients signed informed consent.
The data that support the findings of this study are available from Institut Curie, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Institut Curie.
F.-C.B. and J.-Y.P. report grants and non-financial support from Menarini Silicon Biosystem, during the conduct of the study. M.C. reports personal fees and other from Novartis, during the conduct of the study; other from Sanofi, Servier, Abbvie, Accord and Astra Zeneca; personal fees from Lilly, outside the submitted work. The other authors have no disclosures.
The trial was funded by grants from La Ligue Contre le Cancer and the French Ministry of Health (PHRC 2009 02-057). The circulating tumour biomarkers laboratory is supported by the Institut Curie SIRIC2 programme (grant INCa-DGOS-INSERM_12554).
Note This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Cabel, L., Berger, F., Cottu, P. et al. Clinical utility of circulating tumour cell-based monitoring of late-line chemotherapy for metastatic breast cancer: the randomised CirCe01 trial. Br J Cancer (2021). https://doi.org/10.1038/s41416-020-01227-3