Test may pre­dict re­lapses in breast can­cer pa­tients

Study looks to give warn­ing sign for risk of re­cur­rence.

The Atlanta Journal-Constitution - - NATION & WORLD - By Marilynn Marchione

A blood test five years af­ter breast can­cer treat­ment helped iden­tify some women who were more likely to re­lapse, long before a lump or other signs ap­peared, a pre­lim­i­nary study found.

It was the largest ex­per­i­ment so far to use these tests, called liq­uid biop­sies, for breast can­cer. Re­sults sug­gest they some­day may help re­veal which women need longer pre­ven­tive ther­apy and which ones can be spared it.

“It could be pro­vid­ing an early warn­ing sign” for some women that can­cer is re­turn­ing, said Dr. Joseph Sparano of Montefiore Ein­stein Cen­ter for Can­cer Care in New York.

On the other hand, “if you had a neg­a­tive test, there was a 98 per­cent chance you would not have a re­cur­rence in the next two years” and per­haps could skip fur­ther treat­ment, he said.

Sparano led the study and gave re­sults Fri­day at the San An­to­nio Breast Can­cer Sym­po­sium.

The test — Cel­lSearch, sold by Me­nar­ini-Sil­i­con Biosys­tems — looks for stray can­cer cells in the blood.

Breast can­cer sur­vivors may be tempted to rush out and get it, but doc­tors say it’s too soon for that. Although it’s been used for about a decade to mon­i­tor cer­tain pa­tients with ad­vanced can­cer dur­ing treat­ment, its value for help­ing to pre­dict breast can­cer re­lapse risk is not well es­tab­lished, and in­sur­ers won’t pay the $600 to $900 tab.

The new study should spur more re­search on this right away, said Dr. Mas­simo Cristo­fanilli, a breast can­cer spe­cial­ist at North­west­ern Univer­sity in Chicago who has used these tests and con­sults for another com­pany de­vel­op­ing one.

“Clearly, to me, we have to do some­thing” now that this study sug­gests a wider role for them, he said.

It in­volved 547 women in long-term fol­low-up from an ear­lier can­cer drug study. Two-thirds of them had can­cers fu­eled by es­tro­gen, and in most cases it had spread to lymph nodes but not more widely.

All had surgery and chemo­ther­apy fol­lowed by hor­mone-block­ing medicines for five years. Guide­lines now rec­om­mend con­sid­er­ing hor­mone block­ers for up to 10 years, but they have side ef­fects and their ben­e­fit be­yond five years is fairly small. So find­ing a way to tell who re­ally needs that would be a big help.

Women in the study had a Cel­lSearch test five years on av­er­age af­ter their can­cer was found and treated.

Among those with es­tro­gen-fu­eled dis­ease, 5 per­cent had can­cer cells in the blood test, and they turned out to have a 22-fold higher risk of re­cur­rence within roughly two years com­pared to women whose blood test was neg­a­tive.

About 65 per­cent of women with hor­mone-pos­i­tive dis­ease and a pos­i­tive blood test did not have a new breast can­cer within two years, but that doesn’t mean the blood test gave a false alarm, Sparano said.

“We haven’t fol­lowed the pa­tients long enough” — it could be that more tu­mors be­come ev­i­dent with more time, he said.

The blood test seemed to do a good job of iden­ti­fy­ing which of these hor­mone-pos­i­tive pa­tients were at low risk of re­cur­rence, sug­gest­ing that women who test neg­a­tive may be able to forgo an ad­di­tional five years of hor­mone-block­ing medicines.

The test did not pre­dict re­cur­rence risk in the rest of the women in the study, whose tu­mors were not fu­eled by es­tro­gen. They have a lower risk of re­cur­rence af­ter five years to start with.

The study was funded by the Breast Can­cer Re­search Foun­da­tion, Su­san G. Komen Foun­da­tion and the Na­tional Can­cer In­sti­tute.


A pa­tient has blood drawn for a liq­uid biopsy in Philadel­phia. A study found that a blood test five years af­ter breast can­cer treat­ment helped iden­tify women who were likely to re­lapse.

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