| Autor: |
Rack, Brigitte, Jückstock, Julia, Günthner-Biller, Maria, Andergassen, Ulrich, Neugebauer, Julia, Hepp, Philip, Schoberth, Alexandra, Mayr, Doris, Zwingers, Thomas, Schindlbeck, Christian, Friese, Klaus, Janni, Wolfgang |
| Předmět: |
|
| Zdroj: |
Archives of Gynecology & Obstetrics; Feb2012, Vol. 285 Issue 2, p485-492, 8p |
| Abstrakt: |
Purpose: Isolated tumor cells (ITC) in the bone marrow of breast cancer patients increase the risk of recurrence and decrease survival, both at primary diagnosis and during follow-up. We tested the efficacy of trastuzumab in clearing HER2/neu-positive ITC from the marrow of patients completing primary treatment. Methods: Ten recurrence-free patients with persistent HER2/neu-positive ITC after routine adjuvant treatment received trastuzumab 6 mg/kg q3w for 12 months in a non-randomized pilot phase II interventional study. Bone marrow ITC HER2/neu status was evaluated at baseline, after treatment for 3, 6 and 12 months, and yearly thereafter, in combination with clinical follow-up. Median follow-up was 23 (15-64) months after baseline bone marrow aspiration. Results: Trastuzumab for 12 months eradicated HER2/neu-positive ITC from bone marrow in all patients ( P = 0.002) and significantly reduced the number of ITC-positive patients ( P = 0.031). However, HER2/neu-negative ITC persisted in three patients immediately after treatment and were detected at yearly bone marrow aspiration in five patients. Two patients with ITC counts ≥5 at yearly follow-up developed metastases and one died. Conclusion: This is the first evidence that trastuzumab is effective in clearing HER2/neu-positive cells from bone marrow during recurrence-free follow-up in breast cancer patients. It also suggests, thanks to the antigen shift phenomenon, an important prognostic role for HER2/neu expression on marrow ITC as a real-time biopsy. However, treatment was mainly effective in patients with HER2/neu-positive ITC. Given the heterogeneity of minimal residual disease, these patients might benefit from a combination of targeted treatment approaches. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
|
Full text from SpringerLink