Tumour Marker Monitoring Plus Imaging May Speed Breast Cancer Metastases Detection

Intensive tumour marker follow-up identifies breast cancer patients who may benefit from imaging for asymptomatic recurrent disease

medwireNews: German researchers believe that combining tumour marker monitoring and whole-body imaging could allow early detection of metastatic recurrence in asymptomatic breast cancer patients.

“Whether patients might benefit from earlier and more accurate tumour detection and improved therapeutic options with a prolonged survival has to be investigated in further studies”, the authors write in the British Journal of Cancer.

“Therefore, a large prospective randomised trial will be needed to draw any firm conclusions.”

The team, led by Dorit Di Gioia, from University Hospital Munich-Grosshadern, measured carcinoembryonic Antigen, cancer antigen (CA) 15-3 and CA 125 levels at 6-week intervals in 813 patients who had completed primary breast cancer treatment.

After a median of 63 months, 44 patients had a significant tumour marker increase from their individual baseline levels and were screened for recurrent disease using whole-body magnetic resonance imaging and/or fluorodeoxyglucose positron emission tomography/computed tomography.

Metastases were detected in the lymph nodes, bone, lung, liver and other sites in 28 (63.7%) of these patients, with one further patient found to have liver metastases on repeat imaging 6 months later, the team reports.

Fourteen (48.3%) of the 29 patients with metastases had lesions in a single organ, seven (24.1%) of whom had limited disease, defined as no more than three lesions. Metastatic disease was identified in between two and six sites in 51.7% of patients.

Overall, 44.8% of patients with metastases were given endocrine therapy and 48.3% were treated with chemotherapy with or without targeted treatment. Five patients with limited disease also underwent locoregional therapy, such as radiation.

In addition, imaging identified secondary malignancies in 13.6% of patients and these individuals were treated with surgery or chemotherapy, with a curative approach taken in 50% of the cases.

Analysis of the 29 patients with metastases gave a median progression-free survival of 9.2 months from diagnosis of distant disease and a median overall survival of 41.1 months.

Survival rates fell from 86.2% at 1 year to 40.0% at 5 years, with a trend towards higher overall survival at 3 and 5 years for patients with limited metastases versus those with disseminated disease, although these differences were not significant.

Finally, the researchers compared metastatic disease patients according to their breast cancer subtype and found that luminal A patients had significantly longer relapse-free survival, but not overall survival, than those with luminal B, HER2-enriched disease or triple negative-breast cancer (TNBC; median 88.4 vs 69.4, 34.0 and 17.5 months, respectively).

Dorit Di Gioia et al conclude that tumour marker measurements with whole-body imaging was “highly effective” for detection and localisation of tumour recurrence.

“We could also show that patients (except patients with TNBC) developed distant metastases more than 60 months after primary diagnosis, which probably could result in continuing follow-up care beyond 5 years in a more intensified way”, they note.

Reference

Di Gioia D, Stieber P, Schmidt GP, et al. Early detection of metastatic disease in asymptomatic breast cancer patients with whole-body imaging and defined tumour marker increase. Br J Cancer 2015; Advance online publication 3 February. doi: 10.1038/bjc.2015.8

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