Increases in circulating tumor cells (CTCs) could predict disease recurrence months before CT scans in patients with locally advanced non-small cell lung cancer (LA-NSCLC). This could guide early salvage treatment approaches, according to research presented at the 2017 Multidisciplinary Thoracic Cancers Symposium.1

In this pilot study, 48 patients with stage II-III LA-NSCLC with no other previous active malignancy underwent definitive chemoradiation. Researchers used an adenoviral probe that detects elevated telomerase activity present in nearly all lung cancer cells to identify CTCs in peripheral blood.

At a median follow-up of 10.9 months, 46% of patients had recurrent disease at a median of 7.6 months after radiotherapy. Post-radiotherapy samples in 20 of 22 recurrences revealed that 15 of these patients (75%) had an increase in CTC counts.

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In 10 of these 15 patients, CTC counts were initially negative in the first post-radiotherapy sampling and increased before CT scans detected recurrence. The median lead time of increased CTC counts preceding radiographic detection of recurrence was 4.7 months.

One patient with early recurrence at 4.7 months had persistently increased CTC counts during and after treatment. Four patients had increased CTC counts after CT scans detected recurrence.

“The additional lead time afforded by an earlier diagnosis may enable doctors to better tailor alternative and salvage treatments to improve their patients’ outcomes and quality of life,” explained first author Chimbu Chinniah, a research fellow in radiation oncology in the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

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“Earlier detection of recurrence may even translate into an increased likelihood of curing these patients when their tumor burden is lowest and thus more likely to respond to therapy.” 


  1. Chinniah C, Aguarin L, Cheng P, et al. Prospective trial of circulating tumor cells as a biomarker for early detection of recurrence in patients with locally advanced non-small cell lung cancer treated with chemoradiation. Paper presented at: 2017 Multidisciplinary Thoracic Cancers Symposium; March 16-18, 2017; San Francisco, CA.