dogma--serial tumor markers not necessary

[Lani]

A recent article suggested a trial to look into whether they might enable
metastatic breast cancer to be detected earlier when it was not so extensive and would perhaps be more treatable--from that article:

Being

[Lani]

A recent article suggested a trial to look into whether they might enable
metastatic breast cancer to be detected earlier when it was not so extensive and would perhaps be more treatable--from that article:

Being confined to bony skeleton is considered a favourable prognostic factor for metastatic
disease [37-38]. Also it has been shown that a single lesion, i.e. minimal metastatic disease
called“stageIVoligometastaticdisease”,amenable tolocaltherapy(surgeryand/orradiation)
followedbyhighdosechemotherapyisconsideredanotherd ifferentfavourablecondition[39-
40]. In these metastatic patients with oligometastatic disease or disease limited to bony
skeleton, median overall survival 2-3 times longer than in general metastatic population is
expected.Inageneralmetastaticpopulationatthepresen tationbonyskeletonasdominantsite
and oligometastatic disease have been reported to involve about 15% [41-43] and 5-10% [38,
44-45] of patients respectively. Therefore, in this study a post-operative follow-up with an
appropriate use of CEA-TPA-CA15.3 tumour marker panel also “early” detected a relatively
high percentage of relapsed patients with limited metastatic disease and more favourable
prognosis.

The article discussed a new marker based in Muc1 which was even better at detecting metastases (hopefully earlier) and suggested it be looked into whether serial testing with CEA-TPA=CA15.3 or the new marker would increase survival by finding and treating metastatic disease earlier.

Why has this dogma remained untested so long?

Yes 15%-25% of metastatic patients is not the majority, but chemotherapy has been recommended for 100% of invasive breast cancer patients in the US when it benefits only 15-35% of them. Unneccessary testing may involve
costs (so does unneccessary chemotherapy), but at least it is without toxicity.

As you recall 20-25% of patients are Her2+ by FISH and it certainly has increased survival by treating them differently(with herceptin)!

Any thoughts?