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Sato N, Hino M, Sano M. Detection of bone metastases in routine follow-up after treatment for primary breast cancer. Breast Cancer 2003; 10:335-40. [PMID: 14634512 DOI: 10.1007/bf02967654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The effect of follow-up after primary treatment for breast cancer on overall survival remains highly questionable, and controversy still exists regarding the benefits of regular follow-up. We therefore attempted to assess the role of intensive follow-up in patients with bone metastases. METHODS We analyzed the survival of 87 breast cancer patients who relapsed first in bone diagnosed either with or without symptoms, from 1985 to 1998. Overall survival (OS) was the main outcome. Recurrence was coded as either asymptomatic, elevated tumor marker, or symptomatic. RESULTS The median disease free interval was 33 months in the asymptomatic group, 42 months in the elevated tumor marker group, and 43 months in the symptomatic group. Overall survival did not differ significantly between the groups. The median OS was 77 months in the asymptomatic group, 78 months in the elevated tumor marker group, and 79 months in the symptomatic group. CONCLUSIONS Our study showed that intensive testing, including assessment of serum tumor markers and bone scans, did not improve OS. The results of our study supported the American Society of Clinical Oncology (ASCO) recommendations that routine use of bone scans is not recommended.
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Affiliation(s)
- Nobuaki Sato
- Department of Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Niigata, Niigata 951-8566, Japan
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52
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Abstract
Adenocarcinoma of the breast is the most common cancer of American women. Increased incidence and reduced mortality have generated a population of more than 2 million breast cancer survivors who require medical follow-up. In addition to therapy-related complications, these women are at risk for locoregional recurrence, distant relapse, and the development of second primary breast tumors. Medical surveillance after primary breast cancer treatment has historically included regular patient history and physical examinations, complete blood cell counts, comprehensive blood chemistries, tumor markers, mammography, chest x-rays, and sometimes computed tomography (CT) and nuclear medicine bone scans. The use of such intensive surveillance was based on the presumption that detecting disease recurrence at its earliest stage would offer the chance of cure, improved survival, or at least improved quality of life. Here we review the evidence that such intensive surveillance is not cost-effective, and in fact has no significant impact on the overall survival or quality of life of women diagnosed with early-stage breast cancer. Finally, we present an evidence-based approach to breast cancer surveillance after therapy that is consistent with several clinical practice guidelines, maximizing outcome and minimizing cost.
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Affiliation(s)
- Leisha A Emens
- Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA
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53
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Li J, Zhang Z, Rosenzweig J, Wang YY, Chan DW. Proteomics and Bioinformatics Approaches for Identification of Serum Biomarkers to Detect Breast Cancer. Clin Chem 2002. [DOI: 10.1093/clinchem/48.8.1296] [Citation(s) in RCA: 640] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Background: Surface-enhanced laser desorption/ionization (SELDI) is an affinity-based mass spectrometric method in which proteins of interest are selectively adsorbed to a chemically modified surface on a biochip, whereas impurities are removed by washing with buffer. This technology allows sensitive and high-throughput protein profiling of complex biological specimens.
Methods: We screened for potential tumor biomarkers in 169 serum samples, including samples from a cancer group of 103 breast cancer patients at different clinical stages [stage 0 (n = 4), stage I (n = 38), stage II (n = 37), and stage III (n = 24)], from a control group of 41 healthy women, and from 25 patients with benign breast diseases. Diluted serum samples were applied to immobilized metal affinity capture Ciphergen ProteinChip® Arrays previously activated with Ni2+. Proteins bound to the chelated metal were analyzed on a ProteinChip Reader Model PBS II. Complex protein profiles of different diagnostic groups were compared and analyzed using the ProPeak software package.
Results: A panel of three biomarkers was selected based on their collective contribution to the optimal separation between stage 0–I breast cancer patients and noncancer controls. The same separation was observed using independent test data from stage II–III breast cancer patients. Bootstrap cross-validation demonstrated that a sensitivity of 93% for all cancer patients and a specificity of 91% for all controls were achieved by a composite index derived by multivariate logistic regression using the three selected biomarkers.
Conclusions: Proteomics approaches such as SELDI mass spectrometry, in conjunction with bioinformatics tools, could greatly facilitate the discovery of new and better biomarkers. The high sensitivity and specificity achieved by the combined use of the selected biomarkers show great potential for the early detection of breast cancer.
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Affiliation(s)
- Jinong Li
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287
| | - Zhen Zhang
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287
| | - Jason Rosenzweig
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287
| | - Young Y Wang
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287
| | - Daniel W Chan
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287
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54
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Sölétormos G, Petersen PH, Nielsen D. Computer-simulated Tumor-Marker Data Used to Compare Progression Criteria for Cytokeratin Tissue Polypeptide Antigen in Metastatic Breast Cancer. Clin Chem 2001. [DOI: 10.1093/clinchem/47.11.2035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- György Sölétormos
- Department of Clinical Biochemistry, Hillerød Hospital, Helsevej 2, DK 3400 Hillerød, Denmark
| | - Per Hyltoft Petersen
- Department of Clinical Biochemistry, Odense University Hospital, 5000 Odense, Denmark
| | - Dorte Nielsen
- Department of Oncology, Herlev Hospital, University of Copenhagen, 2730 Copenhagen, Denmark
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55
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Bast RC, Ravdin P, Hayes DF, Bates S, Fritsche H, Jessup JM, Kemeny N, Locker GY, Mennel RG, Somerfield MR. 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19:1865-78. [PMID: 11251019 DOI: 10.1200/jco.2001.19.6.1865] [Citation(s) in RCA: 634] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To update the 1997 clinical practice guidelines for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast and colorectal cancers. These guidelines are intended for use in the care of patients outside of clinical trials. OPTIONS Six tumor markers for colorectal cancer and eight for breast cancer were considered. They could be recommended or not for routine use or for special circumstances. In addition to carcinoembryonic antigen (CEA) and CA 15-3, CA 27.29 was also considered among the serum tumor markers for breast cancer. OUTCOMES In general, the significant health outcomes identified for use in making clinical practice guidelines (overall survival, disease-free survival, quality of life, lesser toxicity, and cost-effectiveness) were used. EVIDENCE A computerized literature search from 1994 to March 1999 was performed. VALUES The same values for use, utility, and levels of evidence were used by the committee. BENEFITS, HARMS, AND COSTS The same benefit, harms, and costs were used. RECOMMENDATION Changes were recommended (see Appendix). VALIDATION The updated recommendations were validated by external review by the American Society of Clinical Oncology's (ASCO's) Health Services Research Committee and by ASCO's Board of Directors. SPONSOR American Society of Clinical Oncology.
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Affiliation(s)
- R C Bast
- American Society of Clinical Oncology, Alexandria, VA 22314, USA.
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56
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Gion M, Mione R, Leon AE, Lüftner D, Molina R, Possinger K, Robertson JF. CA27.29: a valuable marker for breast cancer management. A confirmatory multicentric study on 603 cases. Eur J Cancer 2001; 37:355-63. [PMID: 11239757 DOI: 10.1016/s0959-8049(00)00396-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recently, a fully automated method has become commercially available to measure the MUC-1-associated antigen CA27.29. The present investigation was performed in order to compare CA27.29 and CA15.3 in a wide series of patients affected with breast cancer. Overall, 603 cases with breast cancer and 194 healthy controls were investigated. Patients were enrolled in 4 institutions, while assays were performed in one laboratory. CA27.29 was measured by the ACS:180 BR assay (Bayer Diagnostics) and CA15.3 by the AxSYM (Abbott Laboratories). An excellent correlation was found between the results obtained by the two methods. The two markers showed comparable results in healthy controls, with higher levels in post-menopausal than in pre-menopausal subjects. The markers were significantly higher in primary breast cancer than in controls. The areas under the receiver operating characteristics (ROC) curves of the two tests were comparable, but CA27.29 showed better sensitivity in cases with low antigen concentrations (below the cut-off point). Accordingly, when comparing each test in different stage categories, significance levels of the differences were higher for CA27.29 than for CA15.3 for all T categories versus healthy controls, for pT1 versus pT2, for all N categories versus healthy controls and for node-negative versus N1-3 patients. From the results of the present study, that has been performed on samples taken at diagnosis and prior to any treatment from the widest series of patients with primary breast cancer reported so far, we can draw the following conclusions: CA27.29 provides comparable results to CA15.3; CA27.29 seems more sensitive than CA15.3 to limited variations of tumour extension; however, it cannot help clinicians in distinguishing stage I patients from stage II patients. However, from the point of view of clinical decision making, CA27.29 provides comparable results to CA15.3. CA27.29 is therefore suitable for routine use in the management of patients with breast cancer.
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Affiliation(s)
- M Gion
- Center for the Study of Biological Markers of Malignancy, General Regional Hospital, ULSS 12, Venice, Italy.
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57
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Tumor Markers. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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58
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Esteva FJ, Fritsche HA. Serum and Tissue Markers for Breast Cancer. Breast Cancer 2001. [DOI: 10.1007/978-0-387-21842-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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59
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Elevated soluble MUC1 levels and decreased anti-MUC1 antibody levels in patients with multiple myeloma. Blood 2000. [DOI: 10.1182/blood.v96.9.3147] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Soluble MUC1 (sMUC1) levels are elevated in many MUC1+cancers. We and others have shown that MUC1 is expressed on multiple myeloma (MM) plasma cells and B cells. In this study, we measured sMUC1 levels in bone marrow (BM) plasma from 71 MM patients and 21 healthy donors (HDs), and in peripheral blood (PB) plasma from 42 MM patients and 13 HDs using an immunoassay that detects the CA27.29 epitope of MUC1. sMUC1 levels were found to be significantly greater (mean 31.76 U/mL, range 5.69 to 142.48 U/mL) in MM patient BM plasma versus HD BM plasma (mean 9.68 U/mL, range 0.65 to 39.83 U/mL) (P < .001). Importantly, BM plasma sMUC1 levels were related to tumor burden because sMUC1 levels were significantly higher for MM patients with active disease (34.62 U/mL, range 5.69 to 142.48 U/mL) versus MM patients with minimal residual disease (16.16 U/mL, range 5.7 to 56.68 U/mL) (P = .0026). sMUC1 levels were also elevated in the PB plasma of MM patients (32.79 U/mL, range 4.15 to 148.84 U/mL) versus HDs (18.47 U/mL, range 8.84 to 42.49) (P = .0052). Lastly, circulating immunglobulin M (IgM) and IgG antibodies to MUC1 were measured in 114 MM patients and 31 HDs, because natural antibodies to MUC1 have been detected in patients with other MUC1-bearing malignancies. These studies demonstrated lower levels of circulating IgM (P < .001) and IgG (P = .078) antibodies to MUC1 in MM patients compared with HDs. Our data therefore show that in MM patients, sMUC1 levels are elevated and correlate with disease burden, whereas anti-MUC1 antibody levels are decreased.
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60
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Abstract
Soluble MUC1 (sMUC1) levels are elevated in many MUC1+cancers. We and others have shown that MUC1 is expressed on multiple myeloma (MM) plasma cells and B cells. In this study, we measured sMUC1 levels in bone marrow (BM) plasma from 71 MM patients and 21 healthy donors (HDs), and in peripheral blood (PB) plasma from 42 MM patients and 13 HDs using an immunoassay that detects the CA27.29 epitope of MUC1. sMUC1 levels were found to be significantly greater (mean 31.76 U/mL, range 5.69 to 142.48 U/mL) in MM patient BM plasma versus HD BM plasma (mean 9.68 U/mL, range 0.65 to 39.83 U/mL) (P < .001). Importantly, BM plasma sMUC1 levels were related to tumor burden because sMUC1 levels were significantly higher for MM patients with active disease (34.62 U/mL, range 5.69 to 142.48 U/mL) versus MM patients with minimal residual disease (16.16 U/mL, range 5.7 to 56.68 U/mL) (P = .0026). sMUC1 levels were also elevated in the PB plasma of MM patients (32.79 U/mL, range 4.15 to 148.84 U/mL) versus HDs (18.47 U/mL, range 8.84 to 42.49) (P = .0052). Lastly, circulating immunglobulin M (IgM) and IgG antibodies to MUC1 were measured in 114 MM patients and 31 HDs, because natural antibodies to MUC1 have been detected in patients with other MUC1-bearing malignancies. These studies demonstrated lower levels of circulating IgM (P < .001) and IgG (P = .078) antibodies to MUC1 in MM patients compared with HDs. Our data therefore show that in MM patients, sMUC1 levels are elevated and correlate with disease burden, whereas anti-MUC1 antibody levels are decreased.
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61
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Sölétormos G, Hyltoft Petersen P, Dombernowsky P. Progression Criteria for Cancer Antigen 15.3 and Carcinoembryonic Antigen in Metastatic Breast Cancer Compared by Computer Simulation of Marker Data. Clin Chem 2000. [DOI: 10.1093/clinchem/46.7.939] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background: We investigated the utility of computer simulation models for performance comparisons of different tumor marker assessment criteria to define progression or nonprogression of metastatic breast cancer.
Methods: Clinically relevant values for progressive cancer antigen 15.3 and carcinoembryonic antigen concentrations were combined with representative values for background variations in a computer simulation model. Fifteen criteria for assessment of longitudinal tumor marker data were obtained from the literature and computerized. Altogether, 7200 different patients, each based on 50 measurements, were simulated. With a sampling interval of 4 weeks, the monitoring period for each event was ∼3.8 years.
Results: Modulation of the background variation, the starting concentrations, and the cutoffs enabled identification of criteria that were robust against false-positive signals of progression.
Conclusions: The computer simulation model is a fast, effective, and inexpensive approach for comparing the diagnostic potential of assessment criteria during clinically relevant conditions of steady-state and progressive disease. The model systems can be used to generate tumor marker assessment criteria for a variety of malignancies and to compare and optimize their diagnostic performance.
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Affiliation(s)
- György Sölétormos
- Departments of Clinical Biochemistry and
- Oncology, Herlev Hospital, University of Copenhagen, 2720 Copenhagen, Denmark
- Department of Clinical Biochemistry, Hillerød Hospital, DK 3400 Hillerød, Denmark
| | - Per Hyltoft Petersen
- Department of Clinical Biochemistry, Odense University Hospital, 5000 Odense, Denmark
| | - Per Dombernowsky
- Oncology, Herlev Hospital, University of Copenhagen, 2720 Copenhagen, Denmark
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62
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Mccoy JL, Rucker R, Petros JA. Cell-mediated immunity to tumor-associated antigens is a better predictor of survival in early stage breast cancer than stage, grade or lymph node status. Breast Cancer Res Treat 2000; 60:227-34. [PMID: 10930110 DOI: 10.1023/a:1006405504158] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cell-mediated immune (CMI) responses to tumor-associated antigens (TAA) in the early postoperative period were examined for correlations with disease recurrence and survival in a 13-year-prospective study of 77 stage 1 and 2 breast cancer patients treated with modified radical or radical mastectomy alone. Among the 21 patients who had positive lymphoproliferative tests using patients' peripheral blood mononuclear cells and autologous TAA of breast cancer cells, only one died from metastatic disease (5%). Among the 56 patients who had a negative test, 23 died from metastatic disease (41%). This difference is statistically significant (p = 0.002) Three other risk factors including tumor size, nodal status and cell differentiation patterns were also analyzed. When these three clinical-pathologic criteria were analyzed individually, none reliably predicted disease recurrence and survival. Nodal status was the most predictive clinical-pathologic risk factor, but was not significant (p = 0.089). The results of this study demonstrate the detection of CMI responses against autologous TAA by lymphoproliferative assays identifies a sub-set of stage 1 and 2 breast cancer patients who are at minimal risk of developing metastatic disease. This testing also identifies immunologically unreactive patients who are at risk for disease recurrence.
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Affiliation(s)
- J L Mccoy
- Immunocomp Laboratory, Inc., Stockbridge, GA 30222, USA
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63
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Affiliation(s)
- M J Duffy
- Department of Nuclear Medicine, St Vincent's Hospital, Dublin, Ireland.
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64
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Abstract
Metastatic breast cancer remains a devastating and largely incurable disease. Currently available therapies offer meaningful palliation for many and modest prolongation of survival for some patients. Single-agent hormonal therapy remains the treatment of choice for patients with ER-positive disease, with sequential use of further hormonal agents or cytotoxic chemotherapy at the time of disease progression. Chemotherapy is appropriate as initial therapy for patients with receptor-negative or rapidly progressive visceral disease. Although combination regimens may increase response rates, the lack of survival benefit does not justify the increased toxicity of aggressive combination regimens in most patients. Maintenance chemotherapy deserves consideration in selected well-informed patients, especially those with few therapy-related side effects. High-dose regimens confer substantial toxicity with no clear therapeutic advantage and cannot be recommended outside of ongoing trials. New chemotherapy agents offer the hope of effective salvage therapy with acceptable toxicity to a larger number of patients. Perhaps most promising, the development of targeted, biologically based therapies such as rhuMAbHER2 offers encouragement for the future.
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Affiliation(s)
- K D Miller
- Division of Hematology and Oncology, Indiana University School of Medicine, Indianapolis, USA
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65
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Stearns V, Yamauchi H, Hayes DF. Circulating tumor markers in breast cancer: accepted utilities and novel prospects. Breast Cancer Res Treat 1999; 52:239-59. [PMID: 10066086 DOI: 10.1023/a:1006137619153] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Detecting and/or monitoring changes in circulating tumor markers might assist in evaluating cancer risk, diagnosis, prognosis, or response to treatment. Several categories of circulating tumor markers have been investigated in breast cancer. These categories include classical tumor-associated antigens, such as CEA and CA 15-3, markers of tumor biology, including markers of angiogenesis, adhesion, and invasion, and antibody response to tumor-associated antigens such as HER2/neu and p53. We used a recently proposed Tumor Marker Utility Grading System to evaluate the use of several circulating tumor markers for different clinical utilities in breast cancer. While there are no tumor markers with established clinical utilities for most uses, tumor-associated antigens can be used for monitoring patients with metastatic disease. In addition, markers of tumor biology such as the circulating extracellular domain of HER2/neu might be useful in determining not only prognosis, but also response to specific treatments. However, further investigations are required to further assess the utility of individual tumor markers for specific clinical uses.
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Affiliation(s)
- V Stearns
- Breast Cancer Program, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
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66
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Smith TJ, Davidson NE, Schapira DV, Grunfeld E, Muss HB, Vogel VG, Somerfield MR. American Society of Clinical Oncology 1998 update of recommended breast cancer surveillance guidelines. J Clin Oncol 1999; 17:1080-2. [PMID: 10071303 DOI: 10.1200/jco.1999.17.3.1080] [Citation(s) in RCA: 196] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine an effective, evidence-based, postoperative surveillance strategy for the detection and treatment of recurrent breast cancer. Tests are recommended only if they have an impact on the outcomes specified by American Society of Clinical Oncology (ASCO) for clinical practice guidelines. POTENTIAL INTERVENTION All tests described in the literature for postoperative monitoring were considered. In addition, the data were critically evaluated to determine the optimal frequency of monitoring. OUTCOME Outcomes of interest include overall and disease-free survival, quality of life, toxicity reduction, and secondarily cost-effectiveness. EVIDENCE A search was performed to determine all relevant articles published over the past 20 years on the efficacy of surveillance testing for breast cancer recurrence. These publications comprised both retrospective and prospective studies. VALUES Levels of evidence and guideline grades were rated by a standard process. More weight was given to studies that tested a hypothesis directly relating testing to one of the primary outcomes in a randomized design. BENEFITS, HARMS, AND COSTS The possible consequences of false-positive and -negative tests were considered in evaluating a preference for one of two tests providing similar information. Cost alone was not a determining factor. RECOMMENDATIONS The attached guidelines and text summarize the updated recommendations of the ASCO breast cancer expert panel. Data are sufficient to recommend monthly breast self-examination, annual mammography of the preserved and contralateral breast, and a careful history and physical examination every 3 to 6 months for 3 years, then every 6 to 12 months for 2 years, then annually. Data are not sufficient to recommend routine bone scans, chest radiographs, hematologic blood counts, tumor markers (carcinoembryonic antigen, cancer antigen [CA] 15-5, and CA 27.29), liver ultrasonograms, or computed tomography scans. VALIDATION The recommendations of the breast cancer expert panel were evaluated and supported by the ASCO Health Services Research Committee reviewers and the ASCO Board of Directors.
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Affiliation(s)
- T J Smith
- American Society of Clinical Oncology, Alexandria, VA 22314, USA
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67
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Bon GG, van Kamp GJ, Verstraeten RA, von Mensdorff-Pouilly S, Hilgers J, Kenemans P. Quantification of MUC1 in breast cancer patients. A method comparison study. Eur J Obstet Gynecol Reprod Biol 1999; 83:67-75. [PMID: 10221613 DOI: 10.1016/s0301-2115(98)00302-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the performance of four serum assays for the quantification of MUC1 in breast cancer patients. STUDY DESIGN A total of 282 serum samples were evaluated with two automated (Boehringer Mannheim Enzymun-Test CA 15-3 and Chiron ACS BR) and two manual assays (Centocor CA 15-3 radioimmunoassay [RIA] and Biomira Truquant BR RIA). Sera were obtained from healthy controls (n=50), patients with benign (n=25) and malignant breast disease (n=77) and patients with other malignancies (n=69). In addition, sera from pregnant women (n=56) and patients with liver cirrhosis (n=5) were included. RESULTS Intraassay coefficients of variation (C.V.s) were highest for the manual Centocor CA 15-3 assay (7.4% for values below 50 kU/l and 8.1% for values above 180 kU/l). Interassay C.Vs were highest for the manual Truquant BR assay (11.7% for the lower concentration values and 18.6% for the higher concentration values). False positive rates ranged between 0% for the Centocor CA 15-3 RIA and 14% for the ACS BR assay (cut-off: 30 kU/l). In monitoring breast cancer patients all four assays show similar patterns, although absolute MUC1 values found may differ up to 50%. CONCLUSION For monitoring purposes all assays perform equally well, however, automated assays show lower inter- and intraassay variability, especially in the higher value range. Therefore we recommend the use of the same, automated, assay for quantification of MUC1 during the follow-up of breast cancer patients.
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Affiliation(s)
- G G Bon
- Department of Obstetrics and Gynecology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
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68
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Abstract
A critical review of CA 27.29 and CA 15-3 is performed in this paper. A review of the literature is undertaken. A review of the FDA submissions for 27.29 for both early stage and monitoring metastatic breast cancer patients is reviewed.
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69
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Agrawal B, Gendler SJ, Longenecker BM. The biological role of mucins in cellular interactions and immune regulation: prospects for cancer immunotherapy. MOLECULAR MEDICINE TODAY 1998; 4:397-403. [PMID: 9791863 DOI: 10.1016/s1357-4310(98)01322-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Among the human mucins, MUC1 is unique in its cell-surface transmembrane expression and its apparent signal-transduction functions. The high expression of MUC1 on many human cancers makes it an attractive target for immunotherapy. Immunization of human cancer patients with MUC1 peptides has resulted in the generation of both anti-MUC1 antibody and cytotoxic T lymphocyte responses. Recently, a novel immunoregulatory role for MUC1 has been suggested by experiments demonstrating that soluble MUC1 induces T-cell unresponsiveness, and that T cells appear to express and secrete MUC1 following their activation. MUC1 is an apparent paradox, having both adhesive and antiadhesive functions, and immunostimulatory and immunosuppressive activities.
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Affiliation(s)
- B Agrawal
- Department of Biochemistry and Molecular Biology, Mayo Clinic Scottsdale, AZ 85259, USA
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70
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Cheli CD, Morris DL, Kish L, Goldblatt J, Neaman I, Allard WJ, Yeung KK, Wu AHB, Moore R, Chan DW, Fritsche HA, Schwartz MK, Very DL. Multicenter evaluation of the Bayer Immuno 1™ CA 15-3™ assay. Clin Chem 1998. [DOI: 10.1093/clinchem/44.4.765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We conducted a multicenter evaluation of the analytical and clinical features of the automated Bayer Immuno 1™ CA 15-3™ assay and compared assay performance to two manual tests. Results of the 10-day imprecision study of the Bayer Immuno 1 assay pooled across four evaluation sites and three lots of reagent produced total CV ≤4%. Lot-to-lot reproducibility for 26 different lots of reagents and calibrators manufactured over a 2-year period was demonstrated (CV, 1.1%). Results for the Bayer Immuno 1 assay correlated well with the Biomira TRUQUANT® BR™ 27.29 and Centocor® CA 15-3 RIAs (r ≥0.94). The upper limit of the reference interval for the Bayer Immuno 1 assay was 35.9 kilounits/L (35.9 units/mL); values were similar for all methods. Longitudinal monitoring of healthy women yielded assay values with an average CV of 11% and 21% for the Bayer Immuno 1 and Biomira assays, respectively. The Bayer Immuno 1 assay demonstrated the analytical features, intermethod correlation, and long-term performance characteristics that are essential for longitudinal monitoring of breast cancer patients.
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Affiliation(s)
- Carol D Cheli
- Bayer Corporation, Business Group Diagnostics, Tarrytown, NY 10591
| | - Deborah L Morris
- Bayer Corporation, Business Group Diagnostics, Tarrytown, NY 10591
| | - Linda Kish
- Bayer Corporation, Business Group Diagnostics, Tarrytown, NY 10591
| | - Joan Goldblatt
- Bayer Corporation, Business Group Diagnostics, Tarrytown, NY 10591
| | - Irene Neaman
- Bayer Corporation, Business Group Diagnostics, Tarrytown, NY 10591
| | - W Jeffrey Allard
- Bayer Corporation, Business Group Diagnostics, Tarrytown, NY 10591
| | - Kwok K Yeung
- Bayer Corporation, Business Group Diagnostics, Tarrytown, NY 10591
| | - Alan H B Wu
- Department of Pathology, Hartford Hospital, Hartford, CT 06102
| | - Robert Moore
- Department of Pathology, Hartford Hospital, Hartford, CT 06102
| | | | | | | | - Donald L Very
- Bayer Corporation, Business Group Diagnostics, Tarrytown, NY 10591
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Agrawal B, Krantz MJ, Reddish MA, Longenecker BM. Cancer-associated MUC1 mucin inhibits human T-cell proliferation, which is reversible by IL-2. Nat Med 1998; 4:43-9. [PMID: 9427605 DOI: 10.1038/nm0198-043] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A number of adenocarcinomas abundantly express and secrete underglycosylated MUC1 mucin. Underglycosylation exposes tandem repeat peptide sequences on cancer-associated MUC1 mucin that are normally cryptic. High levels of MUC1 mucin are correlated with a poor prognosis and immunosuppression in adenocarcinoma patients. In this report we show that cancer-associated MUC1 mucin, affinity-purified from ascites fluids of cancer patients, and synthetic tandem repeats of MUC1 mucin core peptide can suppress human T-cell proliferative responses. This MUC1 mucin-induced suppression of T-cell responses can be reversed by the addition of exogenous IL-2 or anti-CD28 monoclonal antibody. These results are consistent with other studies showing that lymphocytes present in the vicinity of tumor cells are anergic and can be reactivated with exogenous interleukin-2. Overcoming MUC1 mucin-induced immunosuppression with IL-2 combined with active specific immunotherapy might be an effective immunotherapeutic strategy against human adenocarcinomas.
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