Figure 4

PIK3CA G1633A mutation detection in CTCs and tissues over time. One patient, Patient 12, with progressive metastatic breast cancer underwent tissue evaluation and PIK3CA sequencing of a bone (spine) metastasis, lung metastasis, bone marrow biopsy and aspirate (DTCs), and sequential blood draws for one and a half years. Eight out of 10 EpCAM-captured single cells (two cells did not get PCR products for sequencing) in the core needle biopsy of a bone metastases (Bone Bx) from the lumbar spine carried the PIK3CA exon 9 heterozygous mutation G1633A; a lung biopsy (Lung Bx) also showed this mutation; 24 out of 24 EpCAM-captured single cells analyzed from the bone marrow biopsy (BM Bx) carried the heterozygous mutation (EpCAM-captured DTCs retrieved from the bone marrow aspirate). The G1633A mutation was detected only twice in CTCs captured from nine blood samples: one week after bone marrow biopsy, with 10/20 EpCAM-captured cells having the mutation, and six weeks after bone marrow biopsy, with 2/7 EpCAM captured cells having the mutation. Drug treatments are noted (RAD001 = everolimus, an mTOR inhibitor). Note that increasing CTC counts dramatically decreased after treatment with capecitabine and everolimus.