Objective measurement of therapeutic response in breast cancer using tumour markers

Abstract

Summary In 65 patients with systemic breast cancer, a biochemical response index using three tumour markers in combination, carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA15-3) and erthrocyte sedimentation rate (ESR), allowed objective biochemical assessment of response to endocrine therapy. Changes in these three markers at 2, 4 and 6 months showed a highly significant correlation with UICC assessed response at 6 months. At 4 months, changes in these three markers resulted in a selectivity of 93%, with a sensitivity of 92% and a specificity of 82%. Survival of groups of patients assessed biochemically or by UICC criteria for non-progression or progression showed no significant difference.The advantages of the biochemical assessment are that it is objective and reproducible. The assessment gives similar information to the UICC assessment but can be carried out earlier. Changes in the three markers appears to reflect the dynamics of change in tumour mass in response to systemic therapy in contrast to the UICC criteria which reflect structural change.

Markers of type I collagen degradation and synthesis in the monitoring of treatment response in bone metastases from breast carcinoma

“…ICTP seemed to be the more reliable indicator of the two metabolites, as expected, since bone lysis should be more closely associated with collagen breakdown than with its synthesis. The diagnostic accuracy of both ICTP and PICP in assessing the treatment response was at the same level as published results on classical tumour markers Ca 15-3 and CEA (Robertson et al, 1991).…”

“…Serum tumour markers, such as CEA and Ca 15-3, may sometimes be useful. In the study by Robertson et al of 65 breast cancer patients treated with endocrine therapy the diagnostic accuracy of CEA and Ca 15-3 for response assessment 4 and 6 months after the start of treatment was higher than 80% (Robertson et al, 1991). About one-fifth of the patients, however, were unassessable owing to marker levels within the normal range and substantial proportions of patients showed a significant marker decrease during disease progression or a marker increase despite an objective tumour response, indicating that the correlation between these epithelial tumour markers and treatment response is far from perfect.…”

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

“…It is generally agreed that tumour markers in breast cancer patients are not a tool for primary diagnosis, because of their low sensitivity and specificity (Tondini et al, 1989;Fateh-Moghadam and Stieber, 1993;Lamerz et al, 1993). Their use for early detection of metastases seems to be promising (Lamerz et al, 1991;Stieber et al, 1992;Vizcarra et al, 1994;O'Hanlon et al, 1995) and their use for measuring therapeutic response in metastatic disease is widely accepted (Tondini et al, 1988;Dnistrian et al, 1991;Robertson et al, 1991;Safi et al, 1991). Many studies tried to assess the prognostic role of these tumour markers (some analysed in serum, some in tissue), but most of them had low patient numbers or short follow-up periods, and used only univariate analyses (Myers Tormey and Waalkes, 1978;Bezwoda et al, 1981;Mansour et al, 1983;Kallioniemi et al, 1988;Hammer et al, 1992;O'Hanlon et al, 1995).…”

Measurement of urinary collagen cross-links indicate response to therapy in patients with breast cancer and bone metastases

“…In contrast, Pyr and Dpyr are released from the bone matrix by osteoclast-mediated resorption stimulated by the tumour-produced factors. CA 15-3 is not produced by every tumour and does not always reliably increase even when the tumour is progressing (Robertson et al, 1991). However, CA 15-3 is of great value for monitoring metastases at other sites.…”

“…These analytes were measured serially and compared with serum levels of the breast tumour-associated antigen CA15-3 (Robertson et al, 1991) and standard International Union Against Cancer (UICC) radiological criteria of response (Hayward et al, 1977).…”