Worsening bone scan in the evaluation of antitumor response during hormonal therapy of breast cancer.

Vogel, Charles L.; Schoenfelder, John R.; Shemano, Irving; Hayes, Daniel; Gams, Richard A.

doi:10.1200/jco.1995.13.5.1123

Cited by 110 publications

(42 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11 Another large study in 433 women confirmed these earlier reports that patients with metastatic disease who had ER negative tumors, visceral metastases, and shorter DFI had significantly worse survival. 12 However, in these earlier series of patients, the newer prognostic markers were not assessed.…”

Section: Discussionmentioning

confidence: 99%

Survival of patients with metastatic breast carcinoma

Chang‐Claude

Clark

Allred

et al. 2003

Cancer

230

View full text Add to dashboard Cite

BACKGROUNDWomen with metastatic breast carcinoma have a highly variable clinical course and outcome. Intrinsic genetic heterogeneity of the primary breast tumor may play a role in this variability and may explain it in part. Therefore, the authors tested the hypothesis that the characteristics of primary breast tumors are important determinants of prognosis and survival in patients with metastatic breast carcinoma.METHODSThe prognostic significance of the biology of the primary tumor for outcome in patients with metastatic breast disease was assessed in 346 patients with lymph node positive breast carcinoma who developed distant, recurrent disease. Traditional prognostic indicators (age, tumor size, number of involved lymph nodes, sites of recurrence, disease free interval [DFI], adjuvant treatments, estrogen receptor [ER] expression, progesterone receptor [PgR] expression, S‐phase fraction [SPF], and DNA ploidy), together with three newer biologic markers (c‐erbB‐2, p53, and bcl‐2) were assessed. Sites of recurrence were defined as nonvisceral (bone and locoregional lymph nodes) or visceral (lung, liver, brain, and other organs).RESULTSThe median duration of survival was 17.8 months (95% confidence interval, 15.2–21.5 months). Univariate analysis showed that age > 50 years, visceral disease, and shorter DFI were associated significantly with poor outcome (P < 0.05). In addition, the molecular phenotype of the primary breast tumor was significant, with primary tumors that showed ER negativity and PgR negativity, high SPF, aneuploidy, accumulation of p53 protein, and lower bcl‐2 expression, together with c‐erbB‐2 overexpression, all associated with a poorer clinical outcome (P < 0.05). In a multivariate analysis, older age, visceral disease, shorter DFI, PgR negativity, high SPF, and lower bcl‐2 expression were significant predictors of worse survival (P < 0.05).CONCLUSIONSIn addition to traditional risk factors, bcl‐2 negativity was associated significantly with a worse clinical outcome. Biologic features of primary tumors were correlated independently with outcome after first recurrence in patients with metastatic breast carcinoma and may be used as indicators of prognosis in the metastatic setting. Cancer 2003;97:545–53. © 2003 American Cancer Society.DOI 10.1002/cncr.11083

show abstract

Section: Discussionmentioning

confidence: 99%

Survival of patients with metastatic breast carcinoma

Chang‐Claude

Clark

Allred

et al. 2003

Cancer

230

View full text Add to dashboard Cite

show abstract

“…In this condition, an apparent worsening of the disease is seen in some patients in the first few weeks of starting tamoxifen treatment; likely before sufficiently high steady-state concentrations of tamoxifen and its active metabolites have accumulated. This is often a favourable sign for responsiveness to tamoxifen therapy since, in the cases where tamoxifen therapy was continued, subsequent tumour regression often occurred (Plotkin et al 1978, Vogel et al 1995. Interestingly, only one other breast cancer cell culture model of 'tamoxifen flare' has been documented previously.…”

Section: Over-expression Of Er-1 In Mcf7 Cells · L C Murphy and Othermentioning

confidence: 99%

Inducible upregulation of oestrogen receptor-β1 affects oestrogen and tamoxifen responsiveness in MCF7 human breast cancer cells

Murphy

Peng²,

Lewis³

et al. 2005

Journal of Molecular Endocrinology

View full text Add to dashboard Cite

To investigate the effect of altered oestrogen receptor (ER) and ER expression on oestrogen and anti-oestrogen action in breast cancer, we have stably expressed an inducible ER 1 in MCF7 breast cancer cells. Stably expressing clones were isolated and over-expression of ER 1 correlated with increased levels of specific radiolabelled oestradiol (E2) binding. Increased ER 1 did not affect endogenous levels of ER but increased progesterone receptor (PR) levels. Over-expression of ER 1 reduced growth responses to E2 in contrast to little if any effect of over-expression of ER . In oestrogen-replete conditions, over-expression of ER 1 but not ER reduced proliferation. Over-expression of ER 1 did not result in anti-oestrogen resistance but was associated with increased sensitivity to 4-hydroxytamoxifen. Our results suggested that over-expression of ER 1 in the presence of an endogenously expressed ER was associated with tamoxifen sensitivity but may negatively modulate ER -mediated growth. However, not all ER activities were inhibited since endogenous PR expression was increased by both ER and ER 1 over-expression. These data paralleled those seen in some in vivo studies showing a relationship between PR and ER expression as well as ER expression and tamoxifen sensitivity of ER-positive breast cancer patients. These models are relevant and will be useful for dissecting the role of ER 1 expression in ER-positive breast cancer.

show abstract

“…These changes are called 'flare phenomenon' and were first reported by Greenberg et al (1972). Flare phenomenon has been reported for prostate cancer and breast cancer, as well as gastroenterological and lung cancers (Killian et al 1981;Cosolo et al 1988;Vogel et al 1995;Amaroso et al 2007). Unfortunately, the clinical significance and mechanisms underlying the flare phenomenon remain poorly understood.…”

mentioning

confidence: 99%

Flare Phenomenon Following Gefitinib Treatment of Lung Adenocarcinoma with Bone Metastasis

Hashisako

Wakamatsu

Ikegame

et al. 2012

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

The skeleton is the most common site for distant metastasis in patients with cancer. To detect bone metastasis and evaluate the efficacy of treatment, we usually use bone scintigraphy and check serum alkaline phosphatase (ALP). However, such evaluation is sometimes difficult due to flare phenomenon. A 61-year-old male was referred to our department with a suspected diagnosis of lung cancer. Following thorough examinations, he was diagnosed with primary lung cancer (adenocarcinoma, Stage IV) and found to have a mutation in the epidermal growth factor receptor gene at exon 21 (L858R). After initiating treatment with oral gefitinib, ALP increased and peaked at 3,592 U/L by 3 weeks and decreased thereafter. At 4 weeks following treatment initiation, bone scintigraphy revealed a marked increase in abnormal accumulation of 99m Tc-polyphosphate, but the primary tumor and metastases in regions other than the bone were reduced. At 9 weeks after treatment initiation, abnormal accumulations was improved in bone scintigraphy, and computed tomography revealed osteoblastic changes consistent with the accumulated lesion observed by bone scintigraphy. After initiating cancer treatment for bone metastasis, it is not uncommon to observe transient asynchronous accumulation in bone scintigraphy or transient increases in ALP in patients who ultimately respond to the treatment. These changes are called flare phenomenon, and documented in patients with prostate cancer or breast cancer receiving treatment. When determining the efficacy of treatments that target carcinomas with bone metastases, it is important to note that flare phenomenon is often indistinguishable from disease progression indicators.

show abstract

Worsening bone scan in the evaluation of antitumor response during hormonal therapy of breast cancer.

Cited by 110 publications

References 14 publications

Survival of patients with metastatic breast carcinoma

Survival of patients with metastatic breast carcinoma

Inducible upregulation of oestrogen receptor-β1 affects oestrogen and tamoxifen responsiveness in MCF7 human breast cancer cells

Flare Phenomenon Following Gefitinib Treatment of Lung Adenocarcinoma with Bone Metastasis

Contact Info

Product

Resources

About