Circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors – a biomarker analysis of the ALICE and ICON trials

Immune checkpoint inhibitors (ICIs) have been introduced in breast cancer (BC) treatment and better biomarkers are needed to predict benefit. Circulating tumor cells (CTCs) are prognostic in BC, but knowledge is limited on CTCs in the context of ICI therapy. In this study, serial sampling of CTCs (C...

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Main Authors: Nikolai Kragøe Andresen, Andreas Hagen Røssevold, Elin Borgen, Cecilie Bendigtsen Schirmer, Bjørnar Gilje, Øystein Garred, Jon Lømo, Marius Stensland, Oddmund Nordgård, Ragnhild Sørum Falk, Randi R. Mathiesen, Hege G. Russnes, Jon Amund Kyte, Bjørn Naume
Format: Article
Language:English
Published: Wiley 2025-07-01
Series:Molecular Oncology
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Online Access:https://doi.org/10.1002/1878-0261.13675
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author Nikolai Kragøe Andresen
Andreas Hagen Røssevold
Elin Borgen
Cecilie Bendigtsen Schirmer
Bjørnar Gilje
Øystein Garred
Jon Lømo
Marius Stensland
Oddmund Nordgård
Ragnhild Sørum Falk
Randi R. Mathiesen
Hege G. Russnes
Jon Amund Kyte
Bjørn Naume
author_facet Nikolai Kragøe Andresen
Andreas Hagen Røssevold
Elin Borgen
Cecilie Bendigtsen Schirmer
Bjørnar Gilje
Øystein Garred
Jon Lømo
Marius Stensland
Oddmund Nordgård
Ragnhild Sørum Falk
Randi R. Mathiesen
Hege G. Russnes
Jon Amund Kyte
Bjørn Naume
author_sort Nikolai Kragøe Andresen
collection DOAJ
description Immune checkpoint inhibitors (ICIs) have been introduced in breast cancer (BC) treatment and better biomarkers are needed to predict benefit. Circulating tumor cells (CTCs) are prognostic in BC, but knowledge is limited on CTCs in the context of ICI therapy. In this study, serial sampling of CTCs (CellSearch system) was evaluated in 82 patients with metastatic BC enrolled in two randomized trials investigating ICI plus chemotherapy. Programmed death‐ligand 1 (PD‐L1) expression on CTCs was also measured. Patients with ≥ 2 CTCs per 7.5 mL at baseline had gene expression profiles in tumor suggestive of increased T‐cell activity, including increased tumor inflammation signature (TIS) in both triple‐negative (P = 0.010) and hormone receptor‐positive (P = 0.024) disease. Patients with luminal A BC had higher CTC levels. The association between CTC status and outcome was most apparent 4 weeks into therapy. PD‐L1 expression in CTCs was observed in 6/17 CTC‐positive patients and was associated with inferior survival. In conclusion, our study indicates that CTC numbers may inform on tumor immune composition, as well as prognosis. These findings suggest a potential of using CTCs as an accessible biomarker source in BC patients treated with immunotherapy.
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spelling doaj-art-d9cb39efb3ac45b4a90bee6aaa9a165e2025-08-20T03:17:43ZengWileyMolecular Oncology1574-78911878-02612025-07-011972092210810.1002/1878-0261.13675Circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors – a biomarker analysis of the ALICE and ICON trialsNikolai Kragøe Andresen0Andreas Hagen Røssevold1Elin Borgen2Cecilie Bendigtsen Schirmer3Bjørnar Gilje4Øystein Garred5Jon Lømo6Marius Stensland7Oddmund Nordgård8Ragnhild Sørum Falk9Randi R. Mathiesen10Hege G. Russnes11Jon Amund Kyte12Bjørn Naume13Department of Clinical Cancer Research Oslo University Hospital NorwayDepartment of Clinical Cancer Research Oslo University Hospital NorwayDepartment of Pathology Oslo University Hospital NorwayDepartment of Pathology Oslo University Hospital NorwayDepartment of Hematology and Oncology Stavanger University Hospital NorwayDepartment of Pathology Oslo University Hospital NorwayDepartment of Pathology Oslo University Hospital NorwayDepartment of Hematology and Oncology Stavanger University Hospital NorwayDepartment of Hematology and Oncology Stavanger University Hospital NorwayOslo Centre for Biostatistics and Epidemiology Oslo University Hospital NorwayDepartment of Oncology Oslo University Hospital NorwayInstitute of Clinical Medicine University of Oslo NorwayDepartment of Clinical Cancer Research Oslo University Hospital NorwayInstitute of Clinical Medicine University of Oslo NorwayImmune checkpoint inhibitors (ICIs) have been introduced in breast cancer (BC) treatment and better biomarkers are needed to predict benefit. Circulating tumor cells (CTCs) are prognostic in BC, but knowledge is limited on CTCs in the context of ICI therapy. In this study, serial sampling of CTCs (CellSearch system) was evaluated in 82 patients with metastatic BC enrolled in two randomized trials investigating ICI plus chemotherapy. Programmed death‐ligand 1 (PD‐L1) expression on CTCs was also measured. Patients with ≥ 2 CTCs per 7.5 mL at baseline had gene expression profiles in tumor suggestive of increased T‐cell activity, including increased tumor inflammation signature (TIS) in both triple‐negative (P = 0.010) and hormone receptor‐positive (P = 0.024) disease. Patients with luminal A BC had higher CTC levels. The association between CTC status and outcome was most apparent 4 weeks into therapy. PD‐L1 expression in CTCs was observed in 6/17 CTC‐positive patients and was associated with inferior survival. In conclusion, our study indicates that CTC numbers may inform on tumor immune composition, as well as prognosis. These findings suggest a potential of using CTCs as an accessible biomarker source in BC patients treated with immunotherapy.https://doi.org/10.1002/1878-0261.13675breast cancercirculating tumor cellsimmune checkpoint inhibitorsliquid biopsy
spellingShingle Nikolai Kragøe Andresen
Andreas Hagen Røssevold
Elin Borgen
Cecilie Bendigtsen Schirmer
Bjørnar Gilje
Øystein Garred
Jon Lømo
Marius Stensland
Oddmund Nordgård
Ragnhild Sørum Falk
Randi R. Mathiesen
Hege G. Russnes
Jon Amund Kyte
Bjørn Naume
Circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors – a biomarker analysis of the ALICE and ICON trials
Molecular Oncology
breast cancer
circulating tumor cells
immune checkpoint inhibitors
liquid biopsy
title Circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors – a biomarker analysis of the ALICE and ICON trials
title_full Circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors – a biomarker analysis of the ALICE and ICON trials
title_fullStr Circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors – a biomarker analysis of the ALICE and ICON trials
title_full_unstemmed Circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors – a biomarker analysis of the ALICE and ICON trials
title_short Circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors – a biomarker analysis of the ALICE and ICON trials
title_sort circulating tumor cells in metastatic breast cancer patients treated with immune checkpoint inhibitors a biomarker analysis of the alice and icon trials
topic breast cancer
circulating tumor cells
immune checkpoint inhibitors
liquid biopsy
url https://doi.org/10.1002/1878-0261.13675
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