Breast cancer tumor make-up changes through the course of disease
New research has found that breast cancer tumours change their hormonal status throughout the course of disease, whereas the decision about the most effective treatment for the patient is usually only based on one biopsy of the primary tumour. For some patients, biopsy verifications of any relapse will be very important because it may completely change their clinical management, a Swedish researcher will tell the 2011 European Multidisciplinary Cancer Congress today (Monday 26 September). Dr. Linda Lindström, from the Karolinska Institutet Department of Oncology-Pathology, Solna, Stockholm, will say that her group's research is the first sizeable study to look at changes in tumours in multiple relapses in breast cancer patients.
"Our study demonstrates tumour instability in clinically used markers throughout tumour progression. We saw, for example, that one in three breast cancer patients alter oestrogen (ER) or progesterone (PR) hormone receptor status, and 15% of patients change human epidermal growth factor receptor 2, or HER2, status during the course of disease," she will say.
ER and PR receptor status tests show whether one or both of these hormones is helping to grow the cancer. Cancer that is hormone positive can be treated by hormone-suppressing drugs, whereas hormone negative cancers may respond to other types of treatment. Hormone negative patients are normally tested for HER2. If this test is positive, treatment such as Herceptin will usually be given.
The researchers studied breast cancer patients in the Stockholm healthcare region who had a recurrence of the disease between January 1, 1997 and December 31, 2007. Information on ER status in several relapses from the same individual was assessed in 119 patients: 33.6% of patients had changes in tumour status between the different sites of relapse (local, loco-regional and metastases) whereas 36.1% of the patients were stable ER positive, and 30.3% were stable ER negative. Sixteen percent of patients changed from ER positive to negative during the course of their disease, 12.6% changed from negative to positive, and 5% altered back and forth throughout tumour progression.
In the PR group, 30.2% of patients altered their hormone receptor status, with the majority changing from positive to negative. "Until now we thought that these predictive markers remained stable during the course of the cancer. But it is now apparent that these breast tumours markers, which are used to decide the best treatment for the patient, change as the tumour progresses and this significantly affects the way patients respond to particular therapies. This has important implications for the future management of the disease," says Dr. Lindström.
The researchers now intend to carry out a prospective study in which they will follow a group of breast cancer patients and examine the standard clinical markers throughout their tumour progression. "With cancer treatments becoming more and more efficacious and targeted to specific groups, it is particularly important that the correct treatment is given throughout the disease," says Dr. Lindström. "An additional advantage of carrying out regular biopsies would be that they could detect other primary cancers, or benign lesions, which could spare patients inappropriate or unnecessary therapies."
Dr. Lindström and colleagues think that their findings could possibly be applied to cancers other than breast. "We believe that tumour instability may be due to many different factors, for instance the choice of therapy and other host (patient) characteristics, and that some inherent tumour behaviour may well be shared by different tumour types. This is a promising area of research with important implications for patient management," she will conclude.
"This finding is of major clinical importance because it shows that many cancer patients who relapse do not receive optimal treatment for their disease. While the price of regular biopsies may seem high for both patients and healthcare systems, in the long run they may avoid inappropriate and costly treatments and, even more importantly, may be the basis for selecting more effective treatments for individual patients," said Professor Michael Baumann, ECCO President.
ESMO spokesman Professor Fabrice André, from the Institut Gustave-Roussy, Villejuif, France, said: "In this study of a large series of patients whose cancer recurred, the investigators have shown molecular changes in the tumours of more than one third. This further underlines the importance of taking regular biopsies in patients who relapse so that they can be sure of getting the most appropriate treatment, and of running trials looking at the relationship between the profiles of metastatic lesions and new agents specifically targeted at them."
Provided by ECCO-the European CanCer Organisation
- Even tiny breast tumors can be aggressive and may require maximum therapy Dec 16, 2007 | not rated yet | 0
- Subtyping breast cancer by immunohistochemistry to investigate survival terms May 25, 2010 | not rated yet | 0
- Survival in metastatic breast cancer patients is improving: targeted therapies have contributed Mar 26, 2010 | not rated yet | 0
- Genes associated with aggressive breast cancer Aug 16, 2010 | not rated yet | 0
- ER/PR negative tumors associated with insurance status Nov 18, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
How can there be villous adenoma in colon, if there are no villi there
15 hours ago As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
- More from Physics Forums - Medical Sciences
More news stories
(HealthDay)—The American Cancer Society, which is celebrating on Wednesday a century of fighting a disease once viewed as a death sentence, is making a pledge to put itself out of business.
Cancer 5 hours ago | not rated yet | 0
National Lung Screening Trial (NLST) investigators also conclude that the 20 percent reduction in lung cancer mortality with low-dose computed tomography (LDCT) versus chest X-ray (CXR) screening previously reported in the ...
Cancer 6 hours ago | not rated yet | 0
Researchers have developed a new drug delivery system that allows inhalation of chemotherapeutic drugs to help treat lung cancer, and in laboratory and animal tests it appears to reduce the systemic damage ...
Cancer 9 hours ago | not rated yet | 0 |
When turned on, the gene p53 turns off cancer. However, when existing drugs boost p53, only a few tumors die – the rest resist the challenge. A study published in the journal Cell Reports shows how: tumors that live even i ...
Cancer 9 hours ago | not rated yet | 0 |
Study leader, Professor John Mathews from the University of Melbourne said this small increase in cancer risk must be weighed against the undoubted benefits from CT scans in diagnosing and monitoring disease.
Cancer 13 hours ago | not rated yet | 0
Swiss scientists reveal the mechanism responsible for aging hidden deep within mitochondria—and dramatically slow it down in worms by administering antibiotics to the young.
10 hours ago | 4.8 / 5 (5) | 0 |
Researchers from Queen Mary, University of London have led the largest sequencing study of human disease to date, investigating the genetic basis of six autoimmune diseases.
10 hours ago | 4 / 5 (1) | 0 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
7 hours ago | 5 / 5 (2) | 2 |
(HealthDay)—Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely—a smaller brain.
6 hours ago | 5 / 5 (1) | 0 |
A new approach for immunizing against influenza elicited a more potent immune response and broader protection than the currently licensed seasonal influenza vaccines when tested in mice and ferrets. The vaccine ...
7 hours ago | not rated yet | 0 |
In a series of lab experiments designed to unravel the workings of a key enzyme widely considered a possible trigger of rheumatoid arthritis, researchers at Johns Hopkins have found that in the most severe ...
9 hours ago | 5 / 5 (1) | 0 |