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Staining of Circulating Tumor Cells - as easy as a blood picture
1. Maintrac®
A tool for monitoring therapy success in solid tumors:
circulating epithelial tumor cells
Based on the presentation of Prof. Dr. med Katharina Pachmann MD
Transfusion Medicine Center Bayreuth TZB, Germany
2. Circulating Tumor Cells
from solid tumors
S Carcinomas are from
epithelial origin
S Carcinomas dissiminate
epithelial cells
⇒ CETCs
(circulating epithelial
tumor cells)
Y.
Shiozawa,
A
M
Havens,
K
J
Pienta
and
R
S
Taichman,
Leukemia
(2008)
22,
941–950
6. Monitoring therapy success
using Circulating Tumor Cells
monitor response to treatment with a particular therapeutic
product for the purpose of adjusting treatment to achieve
improved safety or effectiveness.
(‚Companoin Diagnostics‘: FDA)
14. Chemo-
sensitivity
J Cancer Therapy 2013,
4:597-605
Chemosensitivity Testing of
Circulating Epithelial Tumor
Cells (CETC) in Vitro:
Correlation to in Vivo
Sensitivity and Clinical
Outcome.
15. Chemo-
sensitivity
• Exposing the blood sample
to different drugs and
concentrations
• Determin the rate of dying
circulating epithelial tumor
cells to identify the most
effective drug for the patient
19. Relapse free survial of patients
with ovarian cancer
N.
Rüdiger
et
al,
J
Cancer
Therapy,
2013,
4,
597-‐605
log rank p≤0.007
Sensitive vs.
resistant tumor
cells to standard
therapy
(carboplatin and
paclitaxel)
23. Good prognosis
Gradual decrease
in cell numbers
during Tamoxifen
therapy
10
100
1.000
10.000
100.000
1.000.000
-‐400 -‐200 0 200 400 600 800 1000 1200 1400
cells/ml
days
Tamoxifen
24. Bad prognosis
Continious
increase
during Tamoxifen
therapy
may proceed to
recurrence 10
100
1.000
10.000
100.000
1.000.000
-‐400 -‐200 0 200 400 600 800 1000 1200 1400
cells/ml
days
Tamoxifen
Relapse
after 849d
Relapse after
1112d
Relapse after
627d
25. K.
Pachmann
et
al,
J
Cancer
Res
Clin
Oncol
2011,
137:821-‐828
Patients with
increasing cell
numbers have
a higher risk
of recurrence
Clinical outcome
26. maintenance
therapy
maintrac
cell counting
every 3 month
Increase
in cell numbers
take
change of therapy
into consideration
maintrac
cell counting
every 3 month
Decrease
in cell numbers
go on with therapy
maintrac
cell counting
every 3 month
If cell numbers
increase,
change of therapy
may be considered
monitor every
3 months
32. Discussion
There is already a
discussion going
on, if it would be
better taking
tamoxifen 10
years instead of
stopping after
5 years.
hWp://am.asco.org/
extending-‐adjuvant-‐tamoxifen-‐reduces-‐breast-‐cancer-‐recurrence-‐mortality
33. Effect of therapy switch
10
100
1000
10000
100000
1000000
08.05.04
20.09.05
02.02.07
16.06.08
29.10.09
13.03.11
AnzahlZellenpromLBlut
4 4
R
Tam Letr
Zol
OP
34. after end
of therapy
maintrac
cell counting
after 3 month
Increase
in cell numbers
restart
maintenance herapy
Decreasing
or stable
cell numbers
maintrac
cell counting
after 3 month
Decreasing
or stable
cell numbers
maintrac
cell counting
every 6 month
If cell numbers
increase,
restart therapy
and monitor
36. Association Transfusion Medicine Center in Bayreuth - TZB
SIMFO Specialized Immunology Science + Development GmbH &
Laboratory Dr. Ulrich Pachmann
Peter Pachmann Laboratory Dr. Pachmann
Kattjahren 8 Kurpromenade 2
22359 Hamburg 95448 Bayreuth
Germany Germany
www.maintrac.de