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05-22-2005, 08:47 AM

Here is an Abstract from ASCO 2005 which needs clarification---were any of your oncologists in attendance to clarify?

Meeting: 2005 ASCO Annual Meeting <nobr>Printer Fr
<nobr>Bo

Category: Breast Cancer
SubCategory: Adjuvant Therapy

Neoadjuvant chemotherapy does not effect presence of micrometastases in bone marrow of breast cancer patients
Abstract No: 867
Author(s):G. Gebauer, T. Fehm, K. Klich, M. Anna-Maria, P. Baier, H. Maul, M. Eichbaum, N. Fersis, C. Sohn
Abstract:Background: The idea of adjuvant systemic therapy in breast cancer patients is to eliminate occult tumor cells which may already disseminate at a very early stage. The presence of occult tumor cells in bone marrow of breast cancer patients without evidence for clinically relevant metastatic disease is associated with worse overall and disease-free survival. However, it is unclear whether cytostatics may eliminate those occult tumor cells. Methods: Bone marrow aspirates obtained during surgery in breast cancer patients with locally resticed disease without evidence of a metastatic tumor cell spread were immunohistochemically stained with anti-cytokeratin antibodies in order to detect disseminated tumor cells. In a matched pair analysis bone marrow results of patients receiving neoadjuvant chemotherapy were matched with patients undergoing surgery first followed by adjuvant therapy. Results: Thirtyfour patients receiving neoadjuvant CTx were included into the analysis and matched for clinical stage and age with 34 breast cancer patients undergoing primary surgery. Detection rate of micrometastases was 23 out of 34 in the neoadjuvant group compared to 13 out of 34 in patients receiving surgery first followd by adjuvant therapy. Both groups did not significantly differ in clincal stage, age or bone marrow status. Interestingly, in 2 patients receiving trastuzumab in a neoadjuvant setting, no disseminated tumor cells were detected after systemic therapy. Conclusions: Our results suggest, that bone marrow status - which is highly correlated to survival - is not affected by cytostatic therapy. Therefore, adjuvant therapies in patients with micrometastases in bone marrow may include additional strategies in order to specifically target cells of a minimal residual disease.
Associated Presentation(s):

Trranslation--chemo alone did not clear the micrometastasis from the bone marrow, but again neoadjuvant chemo is usually given for a relatively short period of time. What wasn't clear was whether the 2 patients were given Herceptin monotherapy (ie, Herceptin alone) or in combination, or in sequence with chemo.

This may have enormous implications in the recommendations regarding what to do for those who do not feel they received optimal therapy ie, in deciding what makes sense in terms of what to do to "catch up"!

Hope this confusion does not produce more frustration!

Lani

PS They have theorized that, since micromets are found years later in people who function normally with NED that having a few cells around in one's bone marrow is fine as long as there are so few that the immune system keeps them under control. The bottom line is--they just do not know. But just because we can measure something, doesn't mean it is something that can do harm!

05-22-2005, 08:47 AM	#4
Lani Guest Posts: n/a	Here is an Abstract from ASCO 2005 which needs clarification---were any of your oncologists in attendance to clarify? Meeting: 2005 ASCO Annual Meeting <nobr>Printer Fr <nobr>Bo Category: Breast Cancer SubCategory: Adjuvant Therapy Neoadjuvant chemotherapy does not effect presence of micrometastases in bone marrow of breast cancer patients Abstract No: 867 Author(s):G. Gebauer, T. Fehm, K. Klich, M. Anna-Maria, P. Baier, H. Maul, M. Eichbaum, N. Fersis, C. Sohn Abstract:Background: The idea of adjuvant systemic therapy in breast cancer patients is to eliminate occult tumor cells which may already disseminate at a very early stage. The presence of occult tumor cells in bone marrow of breast cancer patients without evidence for clinically relevant metastatic disease is associated with worse overall and disease-free survival. However, it is unclear whether cytostatics may eliminate those occult tumor cells. Methods: Bone marrow aspirates obtained during surgery in breast cancer patients with locally resticed disease without evidence of a metastatic tumor cell spread were immunohistochemically stained with anti-cytokeratin antibodies in order to detect disseminated tumor cells. In a matched pair analysis bone marrow results of patients receiving neoadjuvant chemotherapy were matched with patients undergoing surgery first followed by adjuvant therapy. Results: Thirtyfour patients receiving neoadjuvant CTx were included into the analysis and matched for clinical stage and age with 34 breast cancer patients undergoing primary surgery. Detection rate of micrometastases was 23 out of 34 in the neoadjuvant group compared to 13 out of 34 in patients receiving surgery first followd by adjuvant therapy. Both groups did not significantly differ in clincal stage, age or bone marrow status. Interestingly, in 2 patients receiving trastuzumab in a neoadjuvant setting, no disseminated tumor cells were detected after systemic therapy. Conclusions: Our results suggest, that bone marrow status - which is highly correlated to survival - is not affected by cytostatic therapy. Therefore, adjuvant therapies in patients with micrometastases in bone marrow may include additional strategies in order to specifically target cells of a minimal residual disease. Associated Presentation(s): Trranslation--chemo alone did not clear the micrometastasis from the bone marrow, but again neoadjuvant chemo is usually given for a relatively short period of time. What wasn't clear was whether the 2 patients were given Herceptin monotherapy (ie, Herceptin alone) or in combination, or in sequence with chemo. This may have enormous implications in the recommendations regarding what to do for those who do not feel they received optimal therapy ie, in deciding what makes sense in terms of what to do to "catch up"! Hope this confusion does not produce more frustration! Lani PS They have theorized that, since micromets are found years later in people who function normally with NED that having a few cells around in one's bone marrow is fine as long as there are so few that the immune system keeps them under control. The bottom line is--they just do not know. But just because we can measure something, doesn't mean it is something that can do harm!