Circulating Tumor Markers in Breast Cancer

Novel sensor for the determination of CA 15-3 in serum of breast cancer patients based on Fe-gallic acid complex doped in modified cellulose polymer thin films

Fe-gallic acid MOF embedded in an epoxy methyl cellulose polymer (CMC) thin film was synthesized and characterized by different micro-analytical tools such as: FE-SEM/EDX, XPS analysis, XRD analysis, FT-IR, and fluorescence spectroscopy. Fe-gallic acid MOF doped in a stable CMC polymer thin film is used as a novel sensor to identify CA 15-3 in the sera of patients suffering breast malignancy. The presence of appropriate functional groups in aqueous CA 15-3 solutions enables it to interact with the Fe-gallic acid MOF embedded in the thin film. The Fe-gallic acid MOF was found to absorb energy at 350 nm (λex) and emits radiation at 439 nm which was specifically quenched in the presence of CA 15-3 over a working concentration range of 0.05-570 U mL-1. In contrast to other CA 15-3 detection methods which suffered from electronic noise, interference and slowness, the Fe-gallic acid MOF proved its sensitivity as an economic, stable and reliable probe for the detection and determination of CA 15-3 in patients' serum samples with a detection limit of 0.01 U mL-1 at pH 7.2.

Correlation study of Carcino Embryonic Antigen & Cancer Antigen 15.3 in pretreated female breast cancer patients

Carcino Embryonic Antigen (CEA) and Cancer Antigen 15.3 (CA15.3) are the most common tumor markers in breast cancer patients. Measurement of circulating tumor markers is a non-invasive quantitative method. Serum levels of CEA and CA 15.3 were studied in female breast cancer patients prior to treatment. To evaluate the utility of these markers, 207 Breast carcinoma patients belonging to all the stages were considered. Healthy age matched 75 female individuals formed the control group. The serum levels of CEA and CA 15.3 were analyzed by Enzyme Linked Immunosorbent Assay (ELISA). Results were taken and compared with stages, tumor size, node and grade. The serum CA 15.3 levels were significant in all the study parameters whereas serum CEA levels showed no significant changes with any of the parameters. Measurement of serum CA 15.3 levels showed significant correlation (24.8%) with advanced stages and larger tumor sizes, whereas serum CEA levels did not show any significant correlation in breast cancer patients prior to treatment.

Determination of carcinoembryonic antigen and cancer antigen (CA 15-3) in bitches with tumours on mammary gland: preliminary report

The aim of this work was to determine levels of carcinoembryonic antigen (CEA) and cancer antigen (CA 15-3) in the blood serum of 45 bitches. A modified procedure was used to determine the CEA and CA 15-3 markers with the human kits using the radioimmunoassay method. Samples collected from extirpated tumour of mammary glands were histologically processed and classified as per WHO guidelines. The average age of animals with tumour was 10.00 ± 2.2 years; for healthy bitches average age was 4.2 ± 3.2 years. Values of CEA and CA 15-3 were considered positive, if they exceeded 0.23 ng mL(-1) and 7 IU mL(-1) , respectively. Average levels of CEA in the tumour group were 0.25 ± 0.06 versus 0.20 ± 0.03 in healthy bitches (P = 0.0001). The average CA 15-3 value in bitches with tumour was 8.58 ± 1.27 versus 5.14 ± 1.34 in healthy animals (P < 0.0001).

The use of carbohydrate antigen (CA) 15-3 as a tumor marker in detecting breast cancer

This study was carried out to determine the sensitivity and specificity of serum CA 15-3 as a marker in detecting and monitoring treatment in, breast cancer patients. One hundred and ten patients comprising 35 known breast cancer patients, 75 suspected cases and 20 controls entered the study. Blood samples were taken before and after treatment from the 35 known cases as well as the 75 suspected cases from which biopsy specimens were also taken. Serum CA 15-3 was measured by BioCheck CA 15-3 Enzyme Immunoassay. There was a significant difference between the concentration of serum CA 15-3 of the 35 known breast cancer patients before and after treatment (p < 0.05). Out of the 75 suspected cases, 46 had breast cancer and 29 had benign breast disease (histologically proven). There was a strong positive correlation between the level of serum CA 15-3 and the histopathology results of the biopsies (r = 0.518). The mean serum CA 15-3 concentration of the 46 patients (80.6 +/- 70.2 U mL(-1)) was significantly higher (p < 0.05) than that of the 29 patients with benign breast disease (12.0 +/- 9.0). The sensitivity and specificity of the serum CA 15-3 in detecting breast cancer was 76.1 and 100%, respectively at a cut-off of 35 U mL(-1). Serum CA 15-3 was found to have a value in the early detection and monitoring of treatment of breast cancer in Ghana.

Serum CEA and CA 15-3 as prognostic factors in primary breast cancer

In the present study, we investigated the association of the serum levels of the tumour markers carcinoembryonic antigen and cancer antigen 15-3 with disease free survival and death from disease in 1046 women with breast cancer without metastases at the time of primary diagnosis in relation to age and the established prognostic factors tumour size, lymph node status, histological grading and hormone receptor status. We found that elevated pre-operative serum marker values were correlated with early relapse (cancer antigen 15-3; P=0.0003) and death from disease (carcinoembryonic antigen, cancer antigen 15-3; P=0.0001 both) in univariate analyses. By comparing pre- and post-operative values we found a decline in values post-surgery. In those patients where marker levels of carcinoembryonic antigen decreased more than 33%, a significantly higher risk for relapse and death from disease (both P=0.0001) in univariate analyses was observed. In multivariate analysis this decrease of carcinoembryonic antigen proved to be an independent prognostic factor. The results for cancer antigen 15-3 were comparable to carcinoembryonic antigen in univariate analyses but showed no significance in multivariate analysis. In this study the post-operative decrease of the serum tumour marker carcinoembryonic antigen was a strong independent prognostic factor for disease free survival and death from disease in breast cancer patients.

Serum tissue polypeptide specific antigen (TPS): a complementary tumor marker to CA 15-3 in the management of breast cancer

The efficacy of CEA and CA15-3 tumor markers in monitoring breast cancer was evaluated in 1365 patients with either benign (n = 534) or malignant (n = 831) breast diseases. Thirty-nine breast cancer patients were monitored before and after neoadjuvant chemotherapy. Three hundred forty-nine patients were monitored during post-surgical follow-up for either a minimum of 5 years or until time of recurrence. Twenty-one patients with metastases were also monitored during chemotherapy. Elevated CA 15-3 and TPS levels were found in 28.6% and 30.0% of patients. CA 15-3 and TPS sensitivities rose to 71.9% and 66.3% in metastatic patients, respectively. The addition of TPS to CA 15-3 increased the sensitivity up to 44.4% in the overall population, and to 87.6% in patients with metastases. During post-surgical follow-up CA 15-3 was elevated in 65.7% and TPS in 61.3% of patients with recurrence. The combination of TPS and CA 15-3 increased the overall sensitivity by 12.7%. Longitudinal monitoring of metastatic patients undergoing chemotherapy demonstrated that, when positive, both CA 15-3 and TPS paralleled response to treatment. TPS monitoring may provide additional value when used in combination with CA15-3 during post-surgical follow-up of breast cancer patients.

Progression Criteria for Cancer Antigen 15.3 and Carcinoembryonic Antigen in Metastatic Breast Cancer Compared by Computer Simulation of Marker Data

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.

Assessment of CA 15.3, CEA and TPA concentrations during monitoring of breast cancer

The variability of the tumor markers cancer antigen (CA) 15.3, carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA) during steady state concentrations and the rate of increase during progression is described. One hundred and ninety-two patients were monitored during first-line chemotherapy for metastatic breast cancer and during follow-up. Blood specimens were sampled approximately every four weeks. Steady state concentrations were registered for 77 (CA 15.3), 96 (CEA), and 127 (TPA) patients with below cutoff level values and for 28 (CA 15.3), 25 (CEA), and 11 (TPA) patients with above cutoff level values. Clinical and marker progression was registered for 75 (CA 15.3), 62 (CEA), and 57 (TPA) patients. The coefficients of total variation of steady state concentrations (comprising the intra- and interassay analytical imprecision and the within subject biological variation) were higher below (14.9% CA 15.3, 15.4% CEA, 25.9% TPA) than above cutoffs (9.6% CA 15.3,6.0% CEA, 19.9% TPA). The variability was similar for CA 15.3 and CEA but higher for TPA. During progression the rates of increase in concentrations were similar for CA 15.3 (0.0257) and CEA (0.0214) and lower than for TPA (0.0346). Our data indicate that criteria for assessment of sequential tumor marker concentrations should consider the marker in question, the steady state variability, the cutoff value, and the rate of increase during disease progression.

Elevated erbB-2 oncoprotein levels in preoperative and follow-up serum samples define an aggressive disease course in patients with breast cancer

BACKGROUND

Recent evidence indicates that a soluble fragment of the erbB-2 oncogene product may be released from cell surface and become detectable in the serum of patients with breast cancer.

METHODS

To study the diagnostic utility of this phenomenon, the authors measured serum erbB-2 levels with a quantitative enzyme-linked immunosorbent assay in 227 preoperative samples from women who underwent breast surgery and in 339 samples from 225 patients with breast cancer during follow-up.

RESULTS

Eleven (9%) of 114 preoperative samples from patients with a histologically verified breast cancer and 2 of 113 (1.8%) from patients with benign breast tumors had elevated (greater than 20 U/ml) serum erbB-2 antigen levels. Ten (91%) of the 11 carcinomas and one of the benign tumors from patients with elevated serum erbB-2 levels also showed overexpression of the erbB-2 protein in immunohistochemical analysis of tissue sections. Elevated preoperative serum erbB-2 levels were predominantly found in patients with large tumors, and those with axillary lymph node or distant metastases. Sixty-three of the 339 (19%) follow-up samples had elevated serum erbB-2 antigen levels. Approximately one-third (30.9%) of the samples taken during recurrent disease were serum erbB-2 positive, which is close to the overall overexpression rate of this oncogene. Elevated erbB-2 levels were more common in patients whose disease was not responsive to treatment. Patients with distant metastases had elevate erbB-2 levels more often (40%) than did those with locoregional recurrence (20%). Elevated erbB-2 levels predicted the appearance of metastases within the next 6 months in 10 of 27 (37%) patients.

CONCLUSION

The study's results suggest that assay serum erbB-2 levels may be valuable in the follow-up and monitoring of patients with breast cancer whose primary tumors show erbB-2 overexpression by immunohistochemistry.

A novel method for monitoring high-risk breast cancer with tumor markers: CA 15.3 compared to CEA and TPA

BACKGROUND

An early and reliable diagnosis of metastatic spread has increased interest in serum tumor markers. This study investigated the ability of CA 15.3, CEA, and TPA to identify, predict, and exclude metastases in bone/viscera during adjuvant treatment and follow-up of high-risk breast cancer.

METHODS

Ninety females with high-risk breast cancer were included in the study. Response evaluation was based upon clinical examination, x-rays or histology and elaborated marker criteria.

RESULTS

During the marker monitoring period, metastases in four patients were confined to skin or lymph nodes, 21 developed metastases to bone/viscera, and 65 females had no evidence of metastases. CA 15.3, CEA, and TPA correctly classified 48%, 10%, and 19% of the patients with metastases in bone/viscera, and 100%, 94%, and 98% without. Following CA 15.3, CEA, and TPA recurrence, 100%, 33%, and 60% of the patients developed metastases in bone/viscera. Metastases in bone/viscera were excluded in 86%, 76%, and 79% of patients without CA 15.3, CEA, and TPA recurrence.

CONCLUSION

Only CA 15.3 gave reliable information about recurrence. Metastases in bone/viscera were identified in 10 of the 21 patients with CA 15.3. There was no false-positive CA 15.3 information on the 65 patients without clinical recurrence. The PVneg (86%) indicated that when CA 15.3 did not signal recurrence, metastases to bone/viscera were not likely.

Carbohydrate antigen 549 in metastatic breast cancer during cytostatic treatment and follow-up

This study was designed to investigate whether the serum tumour marker CA 549 gave early and reliable information about disease activity among metastatic breast cancer patients during cytostatic treatment and follow-up. 50 females with metastatic breast cancer were monitored clinically and with the tumour marker CA 549. Response evaluation was based upon clinical (World Health Organization) and elaborated CA 549 criteria, respectively. In 113 blindly and matched evaluations, concordance appeared in 73/113 and discordance in 40/113 evaluations. In 27, discordance concerned degree of response, in 2 clinical progression followed marker progression after the end of the study, and in 11 progressive disease was established by clinical investigation alone. CA 549 response excluded clinical progression in bone or viscera and reversed. Clinical progression within 2 months in viscera and bone was predicted among 91% by marker progression. Clinical progression was excluded among 93% without marker progression. In conclusion, monitoring of metastatic breast cancer patients could include CA 549 if standardised criteria for marker evaluation are used.

Analysis of cytosol CA15-3, carcinoembryonic antigen, estrogen and progesterone receptors in breast cancer tissues

Cytosol levels of carcinoembryonic antigen (CEA), CA15-3, estrogen receptor (ER) and progesterone receptor (PgR) of 194 primary breast cancer tissues were measured. ER and PgR determined by enzyme immunoassay methods correlated inversely with Page's grades of histological atypia and mitotic rate. Cytosol CA15-3 correlated inversely with the grades of tubular and nuclear atypia and positively with the mitotic rate. CA15-3 correlated positively with ER and PgR. Cytosol CEA showed no correlation with the pathological grade or hormone receptor status. These results indicate that hormone receptor-positive breast cancers tend to have more differentiated morphology and slower growth rate than those without those receptors and that the cytosol CA15-3 level may reflect some of the intrinsic malignant potency, particularly the growth rate, of breast cancer. Cytosol CA15-3 as well as the hormone receptor status may have prognostic value for patients with breast cancer.

Cytosol albumin content in operable breast cancer. Correlations to steroid hormone receptors, other prognostic factors and prognosis

Albumin content has been reported to be significantly different in cytosols from benign and malignant breast tumors, with a higher level in benign lesions. Low albumin content is suggested to be associated with a higher tendency to axillary nodal involvement in breast cancer patients. Albumin contributes greatly to the total amount of protein in tumor cytosol, and is easily measured. Albumin was measured in cytosols from 382 patients with breast cancer stage I and II, to evaluate correlations to other tumor variables and to investigate whether it may add information as a prognostic factor. The albumin content was expressed in percentages of total cytosol protein, with a median value of 18.5% for the study population. It was found to be significantly inversely correlated to estrogen receptor (ER) content. Cytosol protein content was inversely correlated to albumin. In addition to tumor size and axillary nodal involvement, albumin content was found to be an independent prognostic factor for relapse-free survival in an analysis of different prognostic variables in patients not given adjuvant endocrine treatment. Low albumin content (less than median) seems to predict effect of adjuvant tamoxifen treatment.