following results of adjuvant treatment with bone marrow aspirations

[Lani]

Research article
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Presence of apoptotic and non apoptotic disseminated tumor cells reflect response to neoadjuvant systemic therapy (NST) in breast cancer
Tanja Fehm MD, PhD , Sven Becker MD, Graziella Pergola-Becker, Karl Sotkar MD, PhD, Gerhard Gebauer MD, Silke Durr-Storzer, Hans Neubauer MD, Diethelm Wallwiener MD, PhD and Erich Solomayer MD, PhD

Breast Cancer Research 2006, 8:R60 doi:10.1186/bcr1611

Published 24 October 2006

Abstract (provisional)

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.


Introduction

Neoadjuvant systemic therapy (NST) is an established strategy to reduce tumor size in breast cancer patients prior to breast conserving therapy. The effect of NST on tumor cell dissemination in these patients is not known. The aim of this study was to investigate (1) the incidence of disseminated tumor cells (DTC) including apoptotic DTC in breast cancer patients after NST and (2) the correlation of DTC status with therapy response.

Methods

Bone marrow aspiration was performed in 157 patients after NST. DTCs were detected by immunocytochemistry using the A45-B/B3 anti-cytokeratin antibody. For detection of apoptotic DTCs the antibody M30 (Roche Diagnostics, Germany) was used which detects a neo-epitope expressed only after caspase cleavage of CK 18 during early apoptosis.

Results

The incidence of DTCs in breast cancer patients was 53% after completion of NST. Tumor dissemination was observed more frequently in patients with no change / progressive disease (NC+PD: 69%) than in patients with partial (PR) or complete remission (CR) of the primary tumor (PR+CR: 46%) (p<0.05). However, 10 of 24 patients with CR were still bone marrow positive. Apoptotic DTCs were present in 36 of 157 (23%) breast cancer patients. In 14% of the patients with PR or CR only apoptotic cells were detected, but only in 4% of the patients with stable disease (SD). In none of the patients with tumor progression apoptotic DTCs were detectable.

Conclusion

The pathological therapy response in breast cancer patients is reflected by the presence of apoptotic DTCs. However, patients with CR may still have non apoptotic DTCs. These patients may also benefit from secondary adjuvant therapy.