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Circulating tumor-cell (CTC) count could be used to choose hormone therapy or chemotherapy as frontline treatment for patients with estrogen receptor-positive (ER+), HER2-negative (HER2-) metastatic breast cancer, according to data from the phase III STIC CTC clinical trial presented at the 2018 San Antonio Breast Cancer Symposium. In the case of discrepancy between CTC count-based treatment choice and physician’s choice of treatment, frontline chemotherapy was associated with a significant gain in overall survival.