1029P - Circulating tumor cells (CTCs) in patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC): frequency, clinical significance...

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Head and Neck Cancers
Translational Research
Basic Principles in the Management and Treatment (of cancer)
Presenter Salvatore Grisanti
Authors S. Grisanti1, C. Almici2, F. Consoli3, R. Verardi2, M. Buglione4, V.D. Ferrari5, A. Bolzoni-Villaret6, P. Nicolai6, S.M. Magrini4, E. Simoncini7
  • 1U.o. Oncologia Medica, Azienda Spedali Civili, 25123 - Brescia/IT
  • 2Lab Manipulation Of Stem Cells, Azienda Spedali Civili, 25123 - Brescia/IT
  • 3U.o. Oncologia Medica, Azienda Spedali Civili, IT-25123 - Brescia/IT
  • 4Radiation Oncology, Università di Brescia, 25123 - Brescia/IT
  • 5Medical Oncology, Azienda Spedali Civili, 25123 - Brescia/IT
  • 6Otorhinolaryngology, University of Brescia, 25123 - Brescia/IT
  • 7Oncologia- Fondazione Beretta, Azienda Spedali Civili, IT-25123 - Brescia/IT



Recurrent/metastatic (R/M) HNSCC have a poor prognosis. Palliative chemotherapy is often used without adequate prognostic and predictive stratification due to the lack of validated predictors in this setting. Furthermore, anti-EGFR therapy is used under the assumption that more than 80% of the primary tumors overexpresses EGFR. CTCs have been identified as prognostic and predictive indicators in several metastatic cancers. We prospectively studied the frequency, clinical significance and EGFR expression of CTCs in pts with R/M HNSCC.

Patients and methods

Pts with local and/or distant relapse of HNSCC at first or second relapse were included between January 2009 and December 2011. CTCs were measured at baseline and at end of treatment or progression. CTCs analysis was performed with the CellSearch® system. The diagnostic performance of the system with squamous cancer cells was tested with cell lines spiking experiments. The CellSearch® fourth channel was used to analyze EGFR expression on CTCs.


Fifty-three pts were evaluable for CTCs analysis and clinical response. CTCs were detected in 14 (26%) pts at baseline and in 22 (41%) pts at any time point. Median CTCs number was 1 CTC/7.5 mL. CTCs were not associated to any of the clinico-pathological variables considered. EGFR was expressed in 45% of CTC-positive pts. After treatment, CTC numbers decreased, remained stable and increased in 8%, 54% and 38% of pts, respectively. Baseline CTCs or their increase were predictive of stable or progressive disease (p .007). In 42 evaluable pts, baseline CTCs were prognostic indicators of worse progression-free (PFS) (3 vs 8 months, p .003) and overall (OS) (5 vs 10 months, p .013) survivals, respectively.


This study demonstrates that: a) low numbers of CTCs are detectable by CellSearch® in more than 40% of R/M HNSCC pts; b) CTCs at baseline or at any time point are independent predictors of poor PFS and OS; c) presence of CTCs during treatment is predictive of chemo-resistant disease; d) EGFR is expressed on CTCs with a high intra-sample and inter-patient variability. These results encourage further development of CTCs in this setting.


All authors have declared no conflicts of interest.