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CELLSEARCH CTC Test in metastatic prostate cancer

(mPC)clinical trials and real-world case studies

Pivotal Trial
Case Study

Case Study
68-year-old patient with hormone-resistant mPC refractory to previous
chemotherapies
Nicholas Vogelzang, MD, Nevada Cancer Institute, Las Vegas, NV

68-year-old male was originally diagnosed with nodal metastasis in 1996; patient
responded to hormone therapy and vaccines until August 2006, when worsening liver,
nodal, and bone metastases were noted

Docetaxel was initiated; by February 2007, the patient experienced progression and
developed docetaxel-related neurological toxicity

At this time, circulating tumor cells (CTCs) were 61 , LDH was 365 IU/L, and
prostate-specific antigen (PSA) level was 10 ng/mL

Patient was treated with an investigational agent without effect; by April 2007, all
tumor markers showed a sharp increase (CTCs=194, lactate dehydrogenase (LDH)=571
IU/L, PSA=23 ng/mL); markers continued to rise following treatment with another
investigational drug

Radiation plus oral cytoxan therapy controlled the disease until November 2007,
after which, tests showed an enlarged liver and malignant supraclavicular adenopathy

At this point, CTCs rose to 621, PSA level rose to 130 ng/mL, and LDH rose to 2602
IU/L; weekly paclitaxel was initiated

Within a month, CTCs declined to 8, LDH levels dropped to 574 IU/L, and
supraclavicular nodes decreased in size; PSA level remained unchanged at 133 ng/mL

Carboplatin was added to therapeutic regimen, after which CTCs declined to 4


(below cutoff), LDH dropped to 306 IU/L, and PSA level decreased to 64 ng/mL

How CTCs helped inform the management of this patient


Circulating tumor cells were monitored regularly after this patients cancer became resistant
to docetaxel and complemented clinical findings and therapeutic results over the course of 1
year of treatment.
This case demonstrates an instance when, in January 2008, 4 weeks after initiation of
paclitaxel, both CTCs and LDH declined, whereas PSA remained unchanged. Previous
studies comparing serial monitoring with CTC testing and PSA have shown that highly
significant differences in overall survival between patients with unfavorable CTCs and
favorable CTCs can be observed at all time points, whereas PSA evaluations were not
significant until 6-8 weeks after the initiation of therapy.1 Furthermore, studies have shown
that, in cases where CTC and PSA changes were discordant, CTC testing provided the
most accurate assessment of prognosis.1
CELLSEARCH CTC Test results should be used in conjunction with all clinical information
derived from diagnostic tests (eg, imaging or laboratory tests), physical examination and
complete medical history, in accordance with appropriate management procedures.
This case study is for educational purposes only and does not constitute professional
medical advice. The information provided in this case study should not be relied upon as
the basis for making patient management decisions. This case study is not intended to
show that any line of therapy is any more or less effective than any other or no therapy.
Please see instructions for use for indications and limitations of the CELLSEARCH CTC
Test as a monitoring aid in management of metastatic breast, colorectal, and prostate
cancer.