American Society of Clinical Oncology 2007 Update of Recommendations for the Use of Tumor Markers in Breast Cancer

Memorial Sloan-Kettering Cancer Center, New York, New York, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 12/2007; 25(33):5287-312. DOI: 10.1200/JCO.2007.14.2364
Source: PubMed


To update the recommendations for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast cancer.
For the 2007 update, an Update Committee composed of members from the full Panel was formed to complete the review and analysis of data published since 1999. Computerized literature searches of MEDLINE and the Cochrane Collaboration Library were performed. The Update Committee's literature review focused attention on available systematic reviews and meta-analyses of published tumor marker studies. In general, significant health outcomes (overall survival, disease-free survival, quality of life, lesser toxicity, and cost-effectiveness) were used for making recommendations. Recommendations and
Thirteen categories of breast tumor markers were considered, six of which were new for the guideline. The following categories showed evidence of clinical utility and were recommended for use in practice: CA 15-3, CA 27.29, carcinoembryonic antigen, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, urokinase plasminogen activator, plasminogen activator inhibitor 1, and certain multiparameter gene expression assays. Not all applications for these markers were supported, however. The following categories demonstrated insufficient evidence to support routine use in clinical practice: DNA/ploidy by flow cytometry, p53, cathepsin D, cyclin E, proteomics, certain multiparameter assays, detection of bone marrow micrometastases, and circulating tumor cells.

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Available from: Robert Mennel, Sep 18, 2014
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    • "To identify cells expressing the Ki67 protein, immunohistochemistry is performed using a mouse monoclonal antibody. MIB-1 antibody has been validated more frequently (Harris et al, 2007). Immunohistochemistry can be used on tissue sections embedded in paraffin. "
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    ABSTRACT: Background: Inconsistencies between mitotic index (MI) and Ki67 measures have been identified in many breast tumour samples. The aim of this study was to describe the prognosis of hormone receptor-positive (HR+) HER2- tumours having discrepant MI and Ki67. Methods: We included a cohort of breast cancer patients initially treated by surgery between 2001 and 2005 in the Institut Curie. Breast cancer-specific survival (BCSS) and disease-free survival (DFS) were analysed according to three proliferation groups: high MI/high Ki67 (MI=3, Ki67>20%), low MI/low Ki67 (MI<3, Ki67⩽20%) and discrepant (high MI/low Ki67 or low MI/high Ki67). Results: Among the 1430 patients, 19.6% had discrepant Ki67 and MI, 11.6% had high markers and 68.8% had low markers. The 5-year BCSS was 95.8%, 95% CI (0.93-0.98) in the discrepant group, 99.3%, 95% CI (0.993-0.999) in the low-proliferation group and 91.8%, 95% CI (0.88-0.96) in the high-proliferation group. In multivariate analysis, the survival of the discrepant group was lower than that of the low-proliferation group: BCSS hazard ratio (HR)=3.01 (1.32-6.84; P=0.008) and DFS HR=2.07, 95% CI (1.31-3.26; P=0.002). Among grade 2 tumours in multivariate analysis, DFS of the discrepant group was lower than that of the low MI/low Ki67 group: HR=1.98, 95% CI (1.14-3.46), P=0.02. Regarding BCSS, the obtained results were similar. Conclusion: The prognosis of patients with discrepant MI and Ki67 appears intermediate between that of low MI/low Ki67 and high MI/high Ki67 groups. These markers should be jointly analysed to clarify prognosis.British Journal of Cancer advance online publication, 17 September 2015; doi:10.1038/bjc.2015.239
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    • "In particular, we observed that t-S100P was significantly more highly expressed (~2-fold) in ER+/PR+ tumors than in receptor-negative tumors. ER+/PR+ breast tumors are often associated with a favorable prognosis [2], notably in the luminal A molecular subtype, but outcomes may be worse for other subtypes [20]. We previously described the positive relationship between S100P and ER/PR positivity in our initial report of S100P as a member of a two-protein biomarker panel [15], and this has also been seen in benign breast disease [21]. "
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    • "The current CellSearch System still cannot meet the need for a point-of-care test since the CTC assignment process is not operated as simple and automatic as the pregnancy test and diabetes test. As a new diagnostic method, the clinical significance of screening CTCs needs to be validated and more evidence should be accumulated to form the acknowledged guidelines and diagnosis criterion [24,34]. "
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