Trastuzumab clears HER2/neu-positive isolated tumor cells from bone marrow in primary breast cancer patients.
Arch Gynecol Obstet
; 285(2): 485-92, 2012 Feb.
Article
in En
| MEDLINE
| ID: mdl-21717141
ABSTRACT
PURPOSE:
Isolated tumor cells (ITC) in the bone marrow of breast cancer patients increase the risk of recurrence and decrease survival, both at primary diagnosis and during follow-up. We tested the efficacy of trastuzumab in clearing HER2/neu-positive ITC from the marrow of patients completing primary treatment.METHODS:
Ten recurrence-free patients with persistent HER2/neu-positive ITC after routine adjuvant treatment received trastuzumab 6 mg/kg q3w for 12 months in a non-randomized pilot phase II interventional study. Bone marrow ITC HER2/neu status was evaluated at baseline, after treatment for 3, 6 and 12 months, and yearly thereafter, in combination with clinical follow-up. Median follow-up was 23 (15-64) months after baseline bone marrow aspiration.RESULTS:
Trastuzumab for 12 months eradicated HER2/neu-positive ITC from bone marrow in all patients (P = 0.002) and significantly reduced the number of ITC-positive patients (P = 0.031). However, HER2/neu-negative ITC persisted in three patients immediately after treatment and were detected at yearly bone marrow aspiration in five patients. Two patients with ITC counts ≥5 at yearly follow-up developed metastases and one died.CONCLUSION:
This is the first evidence that trastuzumab is effective in clearing HER2/neu-positive cells from bone marrow during recurrence-free follow-up in breast cancer patients. It also suggests, thanks to the antigen shift phenomenon, an important prognostic role for HER2/neu expression on marrow ITC as a real-time biopsy. However, treatment was mainly effective in patients with HER2/neu-positive ITC. Given the heterogeneity of minimal residual disease, these patients might benefit from a combination of targeted treatment approaches.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Bone Marrow
/
Breast Neoplasms
/
Receptor, ErbB-2
/
Antibodies, Monoclonal, Humanized
/
Neoplastic Cells, Circulating
/
Antineoplastic Agents
Type of study:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Middle aged
Language:
En
Journal:
Arch Gynecol Obstet
Journal subject:
GINECOLOGIA
/
OBSTETRICIA
Year:
2012
Type:
Article
Affiliation country:
Germany