dogma--serial tumor markers not necessary
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 |
another try
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? |
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