"Tumour marker guided" salvage treatment prolongs survival of breast cancer patients: final report of a 7-year study.
OBJECTIVE
Randomised trials on breast cancer showed no significant benefit from post-operative follow-up with clinical and/or conventional radiological means. We hypothesised that carcinoembryonic antigen (CEA), tissue polipeptyde antigen (TPA), breast cancer associated antigen 115 D8/DF3 (CA15.3) tumour marker panel is sensitive enough for significantly anticipating salvage treatment and prolonging survival of relapsing breast cancer patients.


METHODS
From October 1981 to May 1999, 68 (62%) of 109 patients with distant metastases were recruited. Thirty-six (53%) received salvage treatment at the time of significant increase in one or more components of CEA-TPA-CA15.3 tumour marker panel and negative instrumental examinations ("tumour marker guided" treatment) and 32 (47%) were treated only after radiological confirmation of metastases (conventional treatment). The prognostic factors of the two groups did not show any statistically significant difference.


RESULTS
The time from one or more tumour marker increase to clear clinical and/or radiological signs of distant metastases (lead time) was significantly prolonged in the 36 patients with "tumour marker guided" treatment (17.3 +/- 13.1 vs. 2.9 +/- 2.9 months, P < 0.001, Wilcoxon test) as well as the survival curves from salvage therapy and from mastectomy (the proportion of survivors was: at 36 months from salvage therapy 28% vs. 9%, P = 0.0094; at 84 months from mastectomy 42% vs. 19%, P = 0.0017). The multivariate Cox analysis showed that time from mastectomy to tumour marker increase and "tumour marker guided" salvage treatment were the only significantly different variables (P = 0.00001 and 0.005, respectively).


CONCLUSIONS
These data point out that "tumour marker guided" salvage treatment significantly prolongs disease-free and overall survivals of relapsing responsive patients.
Nicolini
Andrea
A
Department of Internal Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy. a.nicolini@int.med.unipi.it
Carpi
Angelo
A
Michelassi
Claudio
C
Spinelli
Claudio
C
Conte
Massimo
M
Miccoli
Paolo
P
Fini
M
M
Giardino
R
R
D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002272:Carcinoembryonic Antigen / Q000097:blood; D005260:Female; D006801:Humans; D008875:Middle Aged; D018396:Mucin-1 / Q000097:blood; D009362:Neoplasm Metastasis; D010455:Peptides / Q000097:blood; D016879:Salvage Therapy / Q000401:mortality
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D018396:Mucin-1; D010455:Peptides; C089984:tissue polypeptide specific antigen