Tumour marker guided salvage treatment prolongs survival of breast cancer patients: final report of a 7-year study

Objectives. - 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 (TRA), 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, Wdcoxon 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 turnour marker guided salvage treatment were the only significantly different variables (P = 0.00001 and 0.005, respectively). Conclusion. -These data point out that -tumour marker guided salvage treatment significantly prolongs disease-free and overall survivals of relapsing responsive patients. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.