“We have a couple trials now that show this,” Julie Gralow, MD, told Cancer Therapy Advisor, referring to Trapp et al and Sparano et al. Dr Gralow is the director of breast medical oncology at Seattle Cancer Care Alliance, Washington. She was not involved in the current study. Now the real question, she said, is whether a treatment can be given at this time point to reduce the risk of recurrence. 

Case in point, an exploratory subgroup analysis in the Trapp et al study found that 10 of 39 triple-negative breast cancer patients with CTC positivity (25.6%) had recurrence. For triple-negative patients that are CTC positive at follow-up, Dr Gralow postulated, would you give chemotherapy at that point when three quarters of patients won’t recur and a quarter will? Patients who have triple-negative breast cancer currently don’t have many FDA-approved therapy options besides chemotherapy.

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“That’s something that we’d have to do a trial [to know] and hopefully it wouldn’t be that we’d give chemo again years down the line,” she said, “but we’d have some other targeted therapy that could be oral and less toxic.”

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A trial called LATER-R that may provide insights into possible interventions is in the very early stages of planning. The trial is being developed by Joseph Sparano, MD, at Montefiore Medical Center, New York, and his colleagues.

Dr Trapp welcomed further study, saying, “A prospective randomized follow-up trial on liquid biopsy is required to validate its power to identify patients with a high risk for recurrence.”


  1. Trapp E, Janni W, Schindlbeck C, et al. Presence of circulating tumor cells in high-risk early breast cancer during follow-up and prognosis [published online October 11, 2018]. J Natl Cancer Inst. doi: 10.1093/jnci/djy152
  2. Sparano J, O’Neill A, Alpaugh K, et al. Association of circulating tumor cells with late recurrence of estrogen receptor-positive breast cancer: a secondary analysis of a randomized clinical trial [published online July 26, 2018.]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.2574