Despite the strong prognostic stratification of circulating tumor cells (CTCs) enumeration in metastatic breast cancer (MBC), current clinical trials usually do not include a baseline CTCs in their design. This study aimed to generate a classifier for CTCs prognostic simulation in existing datasets for hypothesis generation in patients with MBC. A K-nearest neighbor machine learning algorithm was trained on a pooled dataset comprising 2436 individual MBC patients from the European Pooled Analysis Consortium and the MD Anderson Cancer Center to identify patients likely to have CTCs >= 5/7 mL blood (StageIV(aggressive) vs StageIV(indolent)). The model had a 65.1% accuracy and its prognostic impact resulted in a hazard ratio (HR) of 1.89 (Simulated(aggressive) vs Simulated(indolent) P < .001), similar to patients with actual CTCs enumeration (HR 2.76; P < .001). The classifier's performance was then tested on an independent retrospective database comprising 446 consecutive hormone receptor (HR)-positive HER2-negative MBC patients. The model further stratified clinical subgroups usually considered prognostically homogeneous such as patients with bone-only or liver metastases. Bone-only disease classified as Simulated(aggressive) had a significantly worse overall survival (OS; P < .0001), while patients with liver metastases classified as Simulated(indolent) had a significantly better prognosis (P < .0001). Consistent results were observed for patients who had undergone CTCs enumeration in the pooled population. The differential prognostic impact of endocrine- (ET) and chemotherapy (CT) was explored across the simulated subgroups. No significant differences were observed between ET and CT in the overall population, both in terms of progression-free survival (PFS) and OS. In contrast, a statistically significant difference, favoring CT over ET was observed among Simulated(aggressive) patients (HR: 0.62; P = .030 and HR: 0.60; P = .037, respectively, for PFS and OS).
Modeling the Prognostic Impact of Circulating Tumor Cells Enumeration in Metastatic Breast Cancer for Clinical Trial Design Simulation / Gerratana, Lorenzo; Pierga, Jean-Yves; Reuben, James M; Davis, Andrew A; Wehbe, Firas H; Dirix, Luc; Fehm, Tanja; Nolé, Franco; Gisbert-Criado, Rafael; Mavroudis, Dimitrios; Grisanti, Salvatore; Garcia-Saenz, Jose A; Stebbing, Justin; Caldas, Carlos; Gazzaniga, Paola; Manso, Luis; Zamarchi, Rita; Bonotto, Marta; Fernandez de Lascoiti, Angela; De Mattos-Arruda, Leticia; Ignatiadis, Michail; Sandri, Maria-Teresa; Generali, Daniele; De Angelis, Carmine; Dawson, Sarah-Jane; Janni, Wolfgang; Carañana, Vicente; Riethdorf, Sabine; Solomayer, Erich-Franz; Puglisi, Fabio; Giuliano, Mario; Pantel, Klaus; Bidard, François-Clément; Cristofanilli, Massimo. - In: THE ONCOLOGIST. - ISSN 1083-7159. - (2022). [10.1093/oncolo/oyac045]
Modeling the Prognostic Impact of Circulating Tumor Cells Enumeration in Metastatic Breast Cancer for Clinical Trial Design Simulation
Gazzaniga, Paola;
2022
Abstract
Despite the strong prognostic stratification of circulating tumor cells (CTCs) enumeration in metastatic breast cancer (MBC), current clinical trials usually do not include a baseline CTCs in their design. This study aimed to generate a classifier for CTCs prognostic simulation in existing datasets for hypothesis generation in patients with MBC. A K-nearest neighbor machine learning algorithm was trained on a pooled dataset comprising 2436 individual MBC patients from the European Pooled Analysis Consortium and the MD Anderson Cancer Center to identify patients likely to have CTCs >= 5/7 mL blood (StageIV(aggressive) vs StageIV(indolent)). The model had a 65.1% accuracy and its prognostic impact resulted in a hazard ratio (HR) of 1.89 (Simulated(aggressive) vs Simulated(indolent) P < .001), similar to patients with actual CTCs enumeration (HR 2.76; P < .001). The classifier's performance was then tested on an independent retrospective database comprising 446 consecutive hormone receptor (HR)-positive HER2-negative MBC patients. The model further stratified clinical subgroups usually considered prognostically homogeneous such as patients with bone-only or liver metastases. Bone-only disease classified as Simulated(aggressive) had a significantly worse overall survival (OS; P < .0001), while patients with liver metastases classified as Simulated(indolent) had a significantly better prognosis (P < .0001). Consistent results were observed for patients who had undergone CTCs enumeration in the pooled population. The differential prognostic impact of endocrine- (ET) and chemotherapy (CT) was explored across the simulated subgroups. No significant differences were observed between ET and CT in the overall population, both in terms of progression-free survival (PFS) and OS. In contrast, a statistically significant difference, favoring CT over ET was observed among Simulated(aggressive) patients (HR: 0.62; P = .030 and HR: 0.60; P = .037, respectively, for PFS and OS).I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
