Abstract PO5-14-02: Diagnostic leukapheresis to increase CTC detection rate in breast cancer patients after 5 years of adjuvant endocrine treatment
Authors: Verschoor Noortje , Kraan Jaco , Zuetenhorst Johanna , Vastbinder Mijntje , Drooger Jan , Sleijfer Stefan , Wilting Saskia M , Martens John WM , Jager Agnes 
Published: May 2024

Abstract
Purpose: Patients with early hormone receptor positive, HER2 negative breast cancer have a risk of recurrence for up to 20 years after the initial diagnosis and is therefore treated with adjuvant endocrine treatment (ET) for 5 to 10 years. As a result there is a large proportion of patients that overtreated, hence, an urgent need for better biomarkers to guide treatment decisions. In previous research, it was shown that circulating tumor cells (CTCs) are detected in 5% of patient after 5 years of adjuvant treatment and that this indicated a 13-fold higher risk of recurrence, with a median lead time of 2.8 years. However, the sensitivity and specificity of the test were moderate. This could be caused by stochastic variation, given the low numbers of CTCs detected in 7.5 ml peripheral blood. We hypothesized that increasing the screening volume, increases the test statistics.
Methods: In this study, we investigated whether increasing the screening volume by diagnostic leukapheresis (DLA) can increase the detection rate of CTCs (CellSearch platform). With DLA, 5 liters of peripheral blood was screened, which in previous studies had shown to increase the CTC-yield per ml by 25-fold. To this end, we included early hormone receptor positive, HER2 negative breast cancer patients that were treated with ET for 4.5-5.5 years with no signs of disease recurrence. We compared the number of detected CTCs in the standard fraction of 7,5 mL peripheral blood (PB), to buffy coat (30 ml), to DLA sample (200 × 109 white blood cells (WBC), equal to 25-50 mL PB) and to DLA after WBC depletion.
Results: Thirty two hormone receptor positive/HER2 negative breast cancer patients were included in this study after a median duration of ET of 60 months, of which 3 (9%) patients completed ET according to clinical guidelines and the remaining patients were still on treatment. Twenty eight patients (88%) had 1-3 positive lymph nodes at diagnosis, and 3 patients had 4-9 positive lymph nodes. The Clinical Treatment Score at 5 years (CTS5 score) was intermediate or high in 75%, and unknown in 19%, indicating a recurrence risk of &gt;5% at years 5-10 after diagnosis. In none of the included patients, CTCs were detected in 7,5 ml PB, nor in any of the other tested blood volumes. To date, 2 patients have been diagnosed with overt metastatic disease during follow-up. DLA was well tolerated and did not cause adverse events.
Conclusions: We conclude that DLA was unable to increase the detection rate of CTCs in hormone receptor positive, HER2 negative patients with early breast cancer being on treatment for a median duration of 5 years. Additional circulating tumor DNA analyses are planned.
Citation Format: Noortje Verschoor, Jaco Kraan, Johanna Zuetenhorst, Mijntje Vastbinder, Jan Drooger, Stefan Sleijfer, Saskia M Wilting, John WM Martens, Agnes Jager. Diagnostic leukapheresis to increase CTC detection rate in breast cancer patients after 5 years of adjuvant endocrine treatment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-14-02.