Ca 15.3 in breast cancer: comparison of two assays and validation in a Mexican population

Ca 15.3 is a tumor marker used for breast carcinoma, since one epitope is an antigen present in milk fat globules. Serum from 171 patients with breast cancer upon initial presentation was studied for Ca 15.3. In the first 72 cases, the authors compared RIA vs. ELISA using a simple linear regression. On the following 99, only ELISA was performed. With all 171 patients, a clinical association between Ca 15.3 measurement and age, stage and hormone receptors was carried out. Correlation coefficient between RIA and ELISA was 0.85. Of 104 patients below 50 years of age, 88 had normal Ca 15.3 and 16, elevated; 67 were older than 50 years, 46 had normal Ca 15.3 and 21, elevated (p=0.022). Ca 15.3 was elevated in 11% of patients with clinical stages I/II, and 89% in stages III/IV (p=0.0001). The association of Ca 15.3 with hormone receptors was not significant. In conclusion, ELISA and RIA measure Ca 15.3 with comparable results, the first method has the advantage of not using radioactivity. The authors found higher probability of elevated Ca 15.3 in older patients and in those with advanced disease.

Profiles of plasma serpins in patients with advanced malignant melanoma, gastric cancer and breast cancer

Blood coagulation and fibrinolysis are activated systemically in patients with malignancy. The precarious balance between coagulation and fibrinolysis is modulated by serine proteinase inhibitors (serpins). Levels of selected serpins (alpha1-antichymotrypsin, alpha1-antitrypsin, alpha2-macroglobulin, antithrombin III, C1 inhibitor, alpha2-antiplasmin), substrates (factor XIIIa, fibrinogen, fibronectin) and endproducts (fibrin/fibrinogen degradation products) of coagulation reactions were measured in the plasma of 61 patients with common malignancies associated with a tendency to thrombosis (i.e. malignant melanoma, gastric cancer and breast cancer). The data revealed a heterogeneity in plasma levels of serpins between tumor types. The most profound differences between cancer and healthy subject groups were found in breast cancer patients. Levels of alpha1-antitrypsin were significantly higher and levels of alpha2-antiplasmin were significantly lower in all cancer groups, whereas there were no differences in antithrombin III levels.

[Increase of oxygen free radicals and their derivatives in chemo- and radiation treated neoplasm patients]

BACKGROUND

Radical oxygen species (ROS) are known to mediate cytotoxic anticancer activity by modifying the cellular homeostatic redox balance. The aim of the study is to evaluate whether cancer patients show more ROS after radio/chemotherapy.

METHODS

ROS were evaluated in 32 oncologic untreated patients. Blood samples were collected both before and after the end of radio/chemotherapy. Spectrophotometric detection of ROS was performed by using d-ROMs test (Diacron).

RESULTS

After therapy all patients showed a marked increase in ROS (378 +/- 35 U Carr) compared to values measured before therapy (269 +/- 62 U Carr, p < 0.0001). This result was more evident during the first course of therapy. No significant differences were observed between patients who received radio or chemotherapy.

CONCLUSIONS

In conclusion both radio and chemotherapy induce oxidative stress by increasing radical oxygen species, exceeding the antioxidative capacities of cancer patients. This is useful for therapeutic purposes but may enhance the cytotoxicity induced by therapy.

Tumor progression and oxidant-antioxidant status

We previously reported on a paradoxical oxidant-antioxidant status in breast cancer patients, more so in pre-menopausal than menopausal women. In this study, measurements were performed on 146 patients with various carcinomas. Vitamin E/total cholesterol increased and plasma malondialdehyde decreased with tumor size and progression. To investigate the difference between young pre-menopausal and aged menopausal breast cancer patients, the same measurements were performed in 365 breast cancer patients according to pathology, tumor size and estrogen receptors. The oxidant-antioxidant status varied with these prognosis factors in the same pattern, and was more pronounced in young than aged women.

Lysosomal aspartic and cysteine proteinases serum levels in patients with pancreatic cancer or pancreatitis

Lysosomal cathepsins D (CD), B (CB), and L (CL) serum levels were determined by immunoassays in patients with chronic (CHP) or acute (AP) pancreatitis and in patients with ductal pancreatic carcinoma (DPC) and correlated with some biological and clinical parameters of this tumor. CB serum concentrations significantly higher than those measured in healthy subjects (NS) were observed in CHP, AP, and DPC patients (p < 0.01). However, no significant difference was noted among these groups. Increased CL serum levels were evident only in cancer patients compared to NS, AP, or CHP groups (p < 0.05), while no difference was observed among these groups. Elevated CD serum values were observed in CHP and AP patients compared to healthy subjects or cancer patients (p < 0.01). In cancer patients no correlation between CD, CB, and CL and clinical stage or tumor size was found. However, significant correlations were observed only between serum CD and CA50 (p < 0.02) and between CD and CL (p < 0.05). No further relationship among the biochemical parameters examined was observed. The present data suggest that the different serum patterns of CD, CB, and CL in patients with pancreatitis and pancreatic cancer may be of clinical interest as additional biochemical parameters for the differential diagnosis of these diseases. However, further prospective clinical studies are needed to assess better their potential value as prognostic parameters to identify patients with pancreatitis at increased risk to develop pancreatic cancer.

The serum tumor marker M3/M21 in the follow-up of breast cancer patients

The aim of this study was to evaluate the new serum tumor marker M3/M21 in comparison to CA 15-3, CEA and MCA in the follow-up of breast cancer patients. We investigated 267 serum samples from 35 patients suffering from invasive breast cancer, International Union Against Cancer (UICC) stage pT1 to pT4. Cut-off values for M3/M21, CA 15-3, CEA, and MCA were 25 U/I, 30 U/I, 5 ng/ml and 11 U/I, respectively. Serum tumor marker results were correlated with the results of the clinical and radiological examinations. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of serum CA 15-3, CEA and MCA were 47/85/61/76%, 24/90/55/70% and 39/84/55/73%, respectively. Serum M3/M21 showed a sensitivity of 45%, specificity of 81%, PPV of 73% and NPV of 69%. The combination of CA 15-3 and M3/M21 increased the sensitivity to 55%, with a specificity, PPV and NPV of 83%, 79% and 86%, respectively. CA 15-3 measurements showed a lead time effect in 5 patients, ranging from 3 to 7 (median 4.1) months. The combination of CA 15-3 and M3/M21 provided lead time effects in 7 cases, ranging from 2 to 8 (median 5.7) months. We conclude that the detection of breast cancer recurrence with CA 15-3 is improved by combination with M3/M21.

Elevated serum c-erbB-2 protein levels in patients with pancreatic cancer: correlation to metastasis and shorter survival

Overexpression of the c-erbB-2 proto-oncogene has been shown to correlate with relapse and poor prognosis in adenocarcinomas of the breast and stomach. In pancreatic cancer, c-erbB-2 overexpression has been demonstrated using immunohistochemistry, but the relationship between serum c-erbB-2 level and clinical data has not been fully evaluated. In this study, serum c-erbB-2 protein levels were measured in 100 patients with pancreatic adenocarcinomas and in 9 patients with mucin-producing tumors. Immunohistochemical studies for c-erbB-2 protein were performed in 36 patients and 4.0 U/ml in healthy controls (p < 0.001). The positive rate for serum c-erbB-2 was 34% (37/109) in patients with pancreatic cancer and 0% (0/66) in patients with gallstones and in healthy controls (p < 0.001). Immunohistochemical study disclosed that the positive staining rate was 28% (8/29) in common ductal adenocarcinoma specimens, 43% (3/7) in metastasis specimens, and 75% (3/4) in mucin-producing tumor specimens. Clinical evaluation revealed that 59% (22/37) of serum c-erbB-2-positive patients and 33% (24/72) of negative patients had liver or peritoneal metastases (p < 0.01). The mean survival time was 154 days in the c-erbB-2-positive group and 220 days in the negative group (p < 0.05). We suppose that c-erbB-2 is related to metastasis and progression of the disease in patients with advanced pancreatic cancer.

Elevated plasma transforming growth factor-beta 1 levels in breast cancer patients decrease after surgical removal of the tumor

OBJECTIVE

The authors determined whether untreated breast cancer patients have elevated plasma levels of transforming growth factor-beta 1 (TGF-beta 1).

SUMMARY BACKGROUND DATA

Increased plasma TGF-beta 1 levels recently were found after chemotherapy in patients with advanced breast cancer. However, it currently is unknown whether this elevation in plasma TGF-beta 1 is caused by chemotherapy-induced normal tissue damage or whether it results from the presence of the tumor.

METHODS

An enzyme-linked immunosorbent assay was used to measure plasma TGF-beta 1 levels in 26 newly diagnosed breast cancer patients before and after definitive surgery. Patients were grouped by postoperative tumor status: 1) negative lymph nodes (group 1); 2) positive lymph nodes (group 2); and 3) overt residual disease (group 3). The site of TGF-beta 1 production in the tumors was localized by immunohistochemistry and in situ hybridization.

RESULTS

Plasma TGF-beta 1 levels were elevated preoperatively in 81% of the patients; TGF-beta 2 and TGF-beta 3 were undetectable. The preoperative TGF-beta 1 levels in the three patient groups were similar; however, the postoperative plasma TGF-beta 1 levels differed by disease status. The mean plasma TGF-beta 1 level in group 1 (n = 12) normalized after surgery (19.3 +/- 3.2 vs. 5.5 +/- 1.0 ng/mL, p < 0.001). In contrast, the mean plasma TGF-beta 1 levels remained above normal in both group 2 (n = 9) and group 3 (n = 5) after surgery. Transforming growth factor-beta 1 expression was found to be preferentially increased in the tumor stroma.

CONCLUSIONS

Breast tumors result in increased plasma TGF-beta 1 levels in 81% of patients. After surgical removal of the primary tumor, the plasma TGF-beta 1 level normalizes in the majority of patients; persistently elevated levels correlate with the presence of lymph node metastases or overt residual tumor. These findings suggest that the usefulness of TGF-beta 1 as a potential plasma marker for breast tumors deserves further study.

[A densitometric analysis of the chromatin structural characteristics of the nuclei in the peripheral blood lymphocytes of breast cancer patients]

Alterations in optical structural characteristics of nuclear chromatin, in comparison with healthy individuals (10) and patients with fibroadenoma (29), were detected in 57 patients with a breast cancer by densitometric investigation of peripheral blood lymphocytes. The degree of these alterations are closely associated with the level of malignancy in the initial neoplasia and the aggregation of oncopathology in pedigrees.

Expression of C-242 antigen in pancreatic ductal adenocarcinoma

This investigation was undertaken in order to analyse the expression of tumor associated antigen CA 242 in normal pancreas, in chronic pancreatitis and in pancreatic ductal adenocarcinoma, and to find out if the expression of CA 242 in carcinoma specimens would have prognostic significance. The expression of CA 242 was examined in the tissue specimens by the avidin-biotin-immunoperoxidase technique. According to our results, normal pancreas showed no or only weak staining for CA 242, whereas chronic pancreatitis samples stained somewhat intensely. Five out of 39 adenocarcinomas were negative for CA 242, 5 showed weak staining and 29 showed intermediate or intense staining. Positive staining was found mostly in the ductal cells as well as in intraluminal contents. We found no statistically significant difference of CA 242 expression between different grades. The staining intensity and survival had no clear statistical correlation but all carcinoma patients whose survival time was more than twelve months showed an intense staining for CA 242. The results suggests that the expression of tumour associated antigen CA 242 may have prognostic significance in pancreatic adenocarcinoma.

Proximal 6q, a region showing allele loss in primary breast cancer

To define regions of deletion of chromosome 6q in breast cancer, we scored 18 (CA)n microsatellites for allelic imbalance (AI) in 42 paired blood/tumour samples. Heterozygosity frequencies of the markers in the sample population ranged from 31% to 92% (mean 68%). Two regions of the chromosome arm showed AI values greater than the background range of 10-22% (mean 17%) of informative cases that was observed with five markers spanning 6q21-q25.2. Firstly, seven markers gave AI values that averaged 35% in a region flanked by D6S313 (AI = 10%) at 6q13 and D6S283 (AI = 17%) at 6q16.3-21. The second region showed marginally increased AI at 6q25.2-q27 and included D6S193, previously shown to be close to a tumour-suppressor gene involved in ovarian carcinoma. Since AI of 6q in breast cancer was shown previously to be due predominantly to loss of heterozygosity, our results suggest the presence of at least two tumour-suppressor genes on 6q that are involved in breast cancer. The proximal region has not been recognised in breast cancer before and is involved in a higher frequency of tumours than the distal region.

Circulating gangliosides of breast-cancer patients

Gangliosides were isolated from the sera of recently diagnosed breast-cancer patients and from individuals who were apparently free of disease. Quantificative and qualitative analyses were carried out by 2-dimensional high-performance thin-layer chromatography and gas chromatography. The locations of isolated gangliosides on thin-layer chromatograms were determined by visualization with resorcinol, and each spot was quantified by digital image densitometry. The ganglioside profiles of cancer patients were compared to those of the control group, revealing a significant increase in total lipid-bound sialic acid and a specific increase in polysialogangliosides in the patients with breast cancer. Furthermore, an increase was noted in the ratio of gangliosides of the b-series biosynthetic pathway over those of the a-series in the cancer sera, as compared to the controls. Gas chromatographic analysis of the peracetylated methanolysis mixtures derived from the total ganglioside fraction of cancer patients supported the HPTLC data, with an increase in total sialic acid, galactose, and sphingosine residues. No unusual gangliosides were found in the mixture from breast-cancer patients.

Diabetes mellitus in pancreatic cancer follow-up

The aim of this study was to assess the behavior of fasting serum glucose, C-peptide levels and OGTT in pancreatic cancer follow-up. We studied 49 patients with pancreatic cancer (stage I = 8 pts; II = 16 pts; III = 12 pts; IV = 13 pts). At diagnosis 13/49 patients had fasting serum glucose levels of above 140 mg/dL. Of the remaining 36 pts, 22 underwent OGTT, which indicated diabetes mellitus in 9/22 (41%) and impaired glucose tolerance in 7/22 (32%) cases. C-peptide basal values were within the normal range (0.8-2.0 micrograms/L) in 14/49 (28%), above 2.0 micrograms/L in 6/49 (13%) and below 0.8 micrograms/L in 29/49 (59%) of the cases. No significant correlation was found between tumor stage or size and the presence of diabetes or of a reduced glucose tolerance. Twenty-four patients underwent curative resection (group 1) and 16 palliative resection, while the remaining nine did not undergo surgery (group 2). Group 1 and 2 patients had a follow-up of 2 to 40 months (mean = 14 months) and from 1 to 7.5 months (mean = 3.5 months) respectively. In group 1 patients no significant difference was found between pre- and post-operative fasting serum glucose levels. However, in 11/15 (73%) patients who underwent OGTT before and after surgery, an improvement in glucose tolerance was observed after tumor resection. In group 2 patients, a significant increase in fasting serum glucose levels was found during follow-up. In neither of the groups studied were significant variations found in C-peptide levels during the follow-up, although a slight increase was observed in patients who did not undergo surgery. In conclusion, the reduced glucose tolerance or frank diabetes mellitus, which frequently occurs during the onset of pancreatic cancer, does not seem to be related to tumor stage or size. Curative resection ameliorates glucose intolerance, while tumor persistence can enhance serum glucose levels.

C-erb-B2 gene amplification and serum level of c-erb-B2 oncoprotein at primary breast cancer diagnosis

We studied c-erb-B2 gene amplification of DNA of primary breast tumours without distant metastasis from 236 women admitted to our institute during 1992. For 125 of them, we had a serum sample at diagnosis, before any treatment. C-erb-B2 gene amplification (> or = 2 copies) was observed in 26% (62/236) of the cases. There was a correlation with higher histological grades (p < 0.03) and with absence of hormone receptors: ER-(p < 0.0001). PgR-(p < 0.0001), association ER- and PgR-(p < 0.0000). Large tumours T3 and T4 taken together tended to present more c-erb B2 gene amplifications (p < 0.08). There was no correlation with age, histological type or nodal status. At diagnosis, mean concentration of serum c-erb-B2 oncoprotein was 8.5 +/- 18 U/ml with a median of 4 U/ml (4-150). Choosing a cut-off value of 8 U/ml gave a sensitivity of 21% (26/125). Serum levels of c-erb-B2 oncoprotein were correlated with tumour spread: large tumours T3-T4 (p < 0.001), nodal involvement (N+) (p < 0.01), association T3-T4 and N+(p < 0.0005), high levels of CA 15:3 (normal value < 25 IU/ml) (p < 0.05). There was no other correlation, particularly with age, histological type, hormone receptors or c-erb-B2 gene amplification. c-erb-B2 oncoprotein serum levels could be helpful to detect recurrences. Assessment of c-erb-B2 oncoprotein serum concentration, before treatment, as an independent prognostic factor is necessary.

CA 50 compared with CA 19-9 as a serum tumour marker for pancreatic carcinoma

This study compared the sensitivity and specificity of CA 50 and CA 19-9 as serum tumour markers for pancreatic cancer. One hundred and seventy one subjects were evaluated: 50 healthy controls, 50 patients with pancreatic carcinoma and 71 patients with chronic pancreatitis. Eighty per cent of the pancreatic cancer patients had raised CA 19-9 serum levels and 82% had raised CA 50 serum levels. In the group of patients ith chronic pancreatitis, false positive tests occurred in 8.4% for CA 19-9 and 11.3% for CA 50. For both markers the serum level showed a severe elevation in the advanced stage of cancer disease. Despite the good sensitivity and specificity of CA 50 as a serum tumour marker for pancreatic carcinoma, no major advantage was found compared to CA 19-9. Moreover, if the CA 50 cut-off, level is raised to 85 U/ml to exclude overlap with chronic pancreatitis, sensitivity falls sharply to 46% compared with 72% for CA 19-9 when a 100 U/ml cut-off level is used.

[PS2 as a prognostic factor in 1065 cases of human breast cancer. A multicenter study]

pS2 protein assay was performed with Elsa-pS2 kit (CIS-Biointernational) on a group of 1,065 patients with operable breast cancer who underwent breast surgery in the years 1982 through 1990. The median follow-up was 57 months. This group included exclusively infiltrating ductal carcinoma with primary surgery. Age mean was 58 yr; T0-T1, 33.6%; T2-T4, 66.4%; Differentiation grade I, 29%; node negative, 53%; estrogen receptor (ER) positive, 62.4%; progesterone receptor (PR) positive, 55.2%; mean tumor size, 2.4 cm; local recurrence, 5.2%; metastasis, 17.5%. pS2 values varied from 0.1 to 707 ng/mg of cytosol protein (median, 5.6; mean 24.5; 95th percentile 112 ng/mg p). There was no significant relationship between the mean level of pS2 and age, tumor size, nodal status, whereas pS2 was related to histological grade (P < 10(-3)), ER (P < 10(-5)), and PR (P < 10(-5)). By using 2 ng/mg p as pS2 cutoff, 77/391 (19.7%) of ER+PR+ tumors were pS2-, and 122/345 (35.4%) of ER-PR-tumors were pS2+; with this cutoff, a strong relationship existed between pS2 and overall survival, but not between pS2 and relapse-free survival. With Cox multivariate analysis, pS2 protein was classified after lymph node status, histological size, ER, differentiation grade, age, clinical stage, PR. In patients with axillary lymph node involvement (N+), pS2 status could discriminate between good and bad prognosis, specially for patients with small tumors (< 2 cm) and with less than seven invaded nodes. This study showed that pS2 protein was a poor prognostic factor in comparison with classical factors.

Genome scanning of breast cancers by two-dimensional DNA typing

We have recently used two-dimensional DNA typing to detect genetic alterations in breast tumours. This method, which is based on size separation in neutral gels and sequence separation in denaturing gradient gels followed by hybridisation analysis with mini- and microsatellite core probes, allows the simultaneous analysis of hundreds of allelic fragments in a very short time. Here we demonstrate the potency of this method for total genome scanning of the tumour genome by analysing a small series of breast cancers. Comparison of tumour and normal DNA from ten breast cancer patients, using two-dimensional DNA typing with four core probes, revealed a considerable number of genomic alterations. In contrast, with Southern blot analysis only a few alterations were observed using the same probes. Most of the changes observed (74%) were deletions (absence of spots in the tumour) while 20% corresponded to amplifications (spots of higher intensity in the tumour) and 5% were new spots (gains). About 10% of the genomic changes detected appeared to occur in the tumours of more than one patient.

erbB-2 and myc oncoproteins in sera and tumors of breast cancer patients

This study compares the prevalence of elevated serological levels of erbB-2 and myc proteins in 36 breast cancer patients and 25 healthy, ambulatory female controls. The controls were frequency matched to the cases by age and ethnicity. Oncoprotein levels were determined blind to the "case-control status" of the individual from whom the specimen was derived. Corresponding tissue levels were examined in tumors of the 13 cases from whom sufficient tissue was available. Serum oncoproteins were elevated as follows: erbB-2 in one control (4%) compared with nine cases (25%; PFisher's exact = 0.03); myc in no control (0%) compared with seven cases (19%; PFisher's exact = 0.02). Elevated serum levels of erbB-2 or myc oncoproteins were detected in four of the seven cases (57.1%) of in situ cancer without evidence of infiltration. In all cases with elevated serum oncoproteins where tumor tissue was available, the corresponding protein was elevated in the tumor. The three cases who had elevated preoperative serum oncoprotein levels and from whom it was possible to procure postoperative specimens had normal postoperative serum oncoprotein levels. We conclude that (a) erbB-2 and myc oncoproteins are elevated in a proportion of breast cancer patients, (b) the tumor seems to be the source of the serum elevation, and (c) these proteins may be useful as part of a panel of biomarkers of early malignant disease.

Natural killer cell activity, phagocytosis, and number of peripheral blood cells in breast cancer patients treated with tamoxifen

The number of leukocytes, proportion and absolute number of granulocytes, lymphocytes, CD4+ cells, CD8+ cells, CD16+ cells, B-lymphocytes, monocytes, natural killer cell (NK) activity, and granulocyte and monocyte phagocytic functions--ingestion and intracellular killing--were determined in a group of 27 patients with ductal invasive breast carcinoma, stage I-III, before and 7 months following postsurgical telecobalt radiotherapy, divided into two subgroups, one of them receiving tamoxifen (TMX group) and the other one not receiving any further therapy (control group). In control group, proportion of all lymphocytes and CD8+ cells as well as absolute number of all lymphocytes, CD4+, CD8+, CD16+ and B lymphocytes were decreased following TCT in comparison to their pre-TCT values, while in TMX group only absolute number of all lymphocytes remained decreased following TCT. Moreover, post-TCT proportions of all and CD8+ lymphocytes as well as absolute numbers of all and CD4+ and CD8+ lymphocytes in TMX patients were significantly increased in comparison to the same parameters in control post-TCT patients, although there was no difference between the two subgroups before TCT. At the other hand, granulocyte ingestion was decreased in post-TCT TMX patients compared to post-TCT values in control patients and NK cell activity showed a similar, although statistically not significant, tendency. It seems that TMX helps recovery of lymphocyte populations decreased by radiotherapy, probably by stimulation of cells carrying estrogen receptors, but its effects on phagocytic functions and probably NK cell activity seemed to be rather inhibitory than stimulatory.

Tamoxifen and hypercalcaemia

The present case demonstrates the importance of close observation, also of serum calcium, when initiating tamoxifen therapy, especially in patients with known osseous metastases. Hypercalcaemia should also be considered as a possible cause of CNS symptoms in patients newly started on endocrine treatment. Hydration with saline is the first step in the management of hypercalcaemia. In patients with a serum calcium level > 3.50 mmol/l (serum ionised calcium approximately 2.00 mmol/l) hydration should be combined with bisphosphonates.