Background: The prognostic significance of CTC in metastatic, as well as in primary breast cancer has been demonstrated (Rack et al., ASCO 2010). The optimal endocrine treatment strategy for postmenopausal patients (pts) with hormone sensitive breast cancer remains unclear.We analyzed the prevalence of CTC two years after primary diagnosis in patients with tamoxifen or anastrozole treatment.
Methods: As part of the translational research project of the German SUCCESS-trial, we analyzed 23ml of peripheral blood from 307 N+ and high risk N-postmenopausal pts with hormone sensitive breast cancer two years after adjuvant taxane based chemotherapy and with tamoxifen or anastrozole treatment. The presence of CTCs was assessed with the CellSearchSystem (Veridex, USA). After immunomagnetic enrichment with an anti-Epcam-antibody, cells were labelled with anti-cytokeratin (8,18,19) and anti-CD45 antibodies to distinguish between epithelial cells and leukocytes. Standard within the study was early switch treatment (tamoxifen for 2 years, followed by anastrozle), while pts with contraindications against tamoxifen were allowed to receive anastrozole up-front.
Results: In 10.1% of pts (n=31) >1 CTC was detected after the completion of chemotherapy (range 2-33), while 7.8% (n=24) presented with >1 CTC (range 2-99) two years after completion of chemotherapy. The median age in the tamoxifen group was 59.9 years and 59.8 in the anastrozole group. In the tamoxifen group, 33.0% of the pts had a pT1 tumor, 5.3% G1 grading and 21.6% of the pts were node negative. In the anastrozole group, 30.0% of the pts had a pT1 tumor, 7.5% G1 grading and 22.5% of the pts were node negative, respectively. None of these differences were statistically significant. After the completion of chemotherapy, 9.7% of the pts were CTC positive in the tamoxifen group (range number of cells: 2-33) and 11.3% in the anastrozole group (range of cells: 2-24), p=0.69. Two years after primary diagnosis, 7.9% of the pts were CTC positive in the tamoxifen group (range number of cells:2-99) and 7.5% in the anastrozole group (range cells: 2-5), p=0.90. Actuarial disease free and overall survival will be presented at the meeting.
Conclusions: The prognostic relevance of CTC in peripheral blood of early breast cancer patients both before and after chemotherapy has been demonstrated. The presented data will add information on the monitoring potential of CTC during adjuvant endocrine treatment.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD04-08.
Background:
Obesity is often associated with an increased risk of dying from breast cancer and poor outcomes of therapy. There are several possible explanations for this phenomenon.
The aim of this analysis was to examine the correlation and potential causality between overweight, obesity and breast cancer. Tumor size, tumor histology, tumor grading and tumor localisation, number of positive lymph nodes, patients age, menopausal status, hormone receptor and HER-2 status are relevant characteristics in prognosis and treatment of breast cancer and at the same time potentially strongly associated with the body mass index.
Patients and Methods:
The ADEBAR study is a german multicenter phase III trial (n=1502). Study-goal was to evaluate whether breast cancer (BC) pts with > 3 axillarylymph node metastases benefit from a sequential anthracycline-docetaxel regimen (E90C-D: 4 cycles epirubicin [E] 90 mg/m2 plus cyclophosphamide [C] 600 mg/m2 q21 days followed by 4 cycles docetaxel [D] 100mg/m2 q21 days) compared to dose-intensive anthracycline-containing polychemotherapy (FE120C: 6 cycles E 60 mg/m2 d 1+8, 5-FU 500mg/m2 d 1+8 and C 75 mg/m2 d 1-14, q4 weeks). For our evaluation at hand Adebar-Patients were grouped according the WHO global database on body mass index (BMI) into normal range (18,50 - 24,99 kg/sqm) and obese (≤30,00 kg/sqm) high risk patients. Results:
There is a strong correlation between body mass index, age and menopausal status at clinical diagnosis of breast cancer. Obese patients (n=300) at diagnosis in median are 55 years old (range 27-71 year) and already postmenopausal (52%, n=209). This analysis shows no connection of tumor localisation (unilateral left or right and bilateral breast cancer) and BMI.The tumor size at clinical diagnosis was strongly associated to the patient's weight (<0.0001). Breast tumors in obese patients have shown a size >3cm in 61 % (n=184) and a size >5cm in 16% (n=47). In normal weight and obese patients there was no sign for a significant difference in the number of positive lymph nodes (p=0.0440), tumor histology (p=0.8028) and grading (p=0.7353). Breast Cancer positivity for ER and PR hormone receptors (ER p=0.7364, PR p=0.4405) and the expression of HER-2 at the tumor surface (p=0.1560) were not significant associated to obesity in study patients. Conclusion:
Our sub analysis between normal weight and obese patients shows a highly significant coherence between body mass index and tumor size in patients with early stage node positive breast cancer.This finding is in line with current publications which show that overweight and obese woman have often been diagnosed at a more advanced stage of disease and the treatment in this patients being less effective as a consequence. Weight reduction and tumor prevention in this high risk collective might be an additional approach on breast cancer therapy.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-11-06.
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