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Tumor cells that invade the blood-stream and reach distant organs are the seeds of death. “Patients with cancer... don't die from the primary tumor, they always die from metastases,” said Leon Terstappen, M.D., Ph.D., chief scientific officer of Immunicon, a Pennsylvania biotechnology company. Because tumor cells make their way to the site of distant metastases via the bloodstream, “there must be cells there,” Terstappen pointed out.

In theory, finding such circulating tumor cells, or CTCs, could identify metastatic disease at its very earliest stage. But the technical hurdles for creating such a clinical test are enormous. “We're looking for really one cell, a weird cell, in a background of maybe 20 million cells,” said David Krag, M.D., professor of surgery at the University of Vermont. “ Boy, that can be really tough.”

But research into circulating tumor cells took a big leap forward in June. In a talk at the American Society of Clinical Oncology (ASCO) annual meeting, University of Michigan medical oncologist Dan Hayes, M.D., reported prospective clinical trial results using a test developed by Immunicon to detect CTCs in patients with metastatic breast cancer. Of 177 cancer patients, nearly 50% had at least five CTCs in a 7.5-milliliter blood sample before chemotherapy treatment, and 30% of these patients still exceeded this five-CTC threshold at a follow-up exam 3 to 4 weeks later. (No patients with benign conditions had more than two CTCs in a blood sample at any time.)

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