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Breast Cancer Research

Volume 13 Supplement 2

IX Madrid Breast Cancer Conference

Open Access

Prognostic value of a high level of circulating endothelial cells in patients with HER2-recurrent or metastatic breast cancer treated with bevacizumab in combination with paclitaxel and gemcitabine as first-line therapy

  • L Manso1,
  • E Ciruelos1,
  • M Codes2,
  • J De la Haba3,
  • A Galan4,
  • J Baena5,
  • A Jaen6,
  • M Gil7,
  • A Murias8,
  • I Blancas9,
  • E Gonzalez10,
  • D Perez11,
  • JL Bayo12,
  • J Mel13,
  • E Garcia-Martinez14,
  • R Cubedo15 and
  • J Salvador16
Breast Cancer Research201113(Suppl 2):P4

Published: 16 November 2011


Breast CancerPaclitaxelBevacizumabGemcitabineMetastatic Breast Cancer


Circulating endothelial cells (CECs) are shed from vessels and enter the circulation reflecting endothelial damage. Increased numbers of CECs have been documented in cancer, and appear to correlate with progression of the tumor. Bevacizumab (B) in combination with CT improves progression-free survival (PFS) of first-line treatments and may modify tumor cell intravasation and CEC/CTC levels.


Patients received B (10 mg/kg/2 weeks) combined with paclitaxel (P) 150 mg/m2 and gemcitabine (G) 2,000 mg/m2 days 1 and 15 with a cycle each 28 days of therapy, until disease progression, unacceptable toxicity or withdrawal. CTC/CECs were measured in 7.5 ml blood at baseline and after the first cycle of treatment. Enumeration was performed by the CellSearch System (Veridex).


Median of follow-up was 16.28 months. Baseline CECs were available for 31 patients. Median value of baseline CECs was 130 (minimum 4 to maximum 1,407) and 60.3 (minimum 0 to maximum 349) in the second determination, P = 0.02. High levels of baseline CECs ≥200 were associated with lower PFS of 8.2 months (95% CI = 0.6 to 10.8) compared with those with <200, PFS 16.9 months (95% CI = 8.78 to NA), P = 0.003. See Figure 1. No difference was observed in OS. Fourteen patients (74%) that had stable disease/partial response decreased or maintained their CEC value. Baseline CTCs ≥5 was associated with a median PFS of 15.2 months (95% CI = 7.6 to 16.9). Twenty-two patients (92%) that had stable disease/partial response decreased or maintained their CTC value. The CTC level was not correlated with the CEC level, P = 0.74.

Figure 1


Our study suggests significant correlations between high levels of baseline CECs and poor prognosis. Addiction of B to first-line CT was related to a high reduction of CEC and CTC count.

Authors’ Affiliations

Hospital 12 de Octubre, Madrid, Spain
Hospital Virgen Macarena, Sevilla, Spain
Hospital Reina Sofía, Córdoba, Spain
Hospital de Sagunto, Spain
Hospital Puerta del Mar, Cádiz, Spain
Hospital de Jaen, Spain
ICO, Bellvitge, Spain
Hospital Insular, Las Palmas de Gran Canaria, Spain
Hospital San Cecilio, Granada, Spain
Hospital Virgen de las Nieves, Granada, Spain
Hospital Costa del Sol, Marbella, Spain
Hospital Juan Ramón Jimenez, Huelva, Spain
Hospital Xeral-Calde, Lugo, Spain
Hospital Morales Messeguer, Murcia, Spain
Hospital Puerta de Hierro, Madrid, Spain
Hospital Universitario de Valme, Sevilla, Spain


© Manso et al. 2011