NEW YORK (Reuters Health) - While high levels of a tumor protein called Ki-67 are associated with worse breast cancer survival, they are not helpful in determining whether patients should receive chemotherapy in addition to estrogen-blocking drugs like tamoxifen, according to a brief report.
Dr. Giuseppe Viale, from the University of Milan in Italy, and colleagues measured Ki-67 levels in tumor samples taken from 1,924 women with "node-negative" breast cancer, which means that the disease has not yet spread to nearby lymph nodes.
The women were drawn from two studies looking at whether chemotherapy was beneficial in patients already receiving estrogen-blocking drugs, according to the findings published in the Journal of the National Cancer Institute.
Ki-67 levels were not useful in determining which women would benefit from chemotherapy, the report indicates. As noted, however, high levels of the protein were linked to worse survival.
In a related editorial, Dr. Matthew J. Ellis, from Washington University in St. Louis, comments that "this study supports the long-held position of the American Society of Clinical Oncology Tumor Markers Expert Panel that measurements of (tumor proteins, such as Ki-67) should not be used for chemotherapy decision making."
SOURCE: Journal of the National Cancer Institute, February 6, 2008.
The study reviewed here found that measuring levels of the protein Ki-67 in breast cancers doesn't help decide who would benefit from chemotherapy in women diagnosed with hormone-receptor-positive, lymph-node-negative early breast cancer. The study did find that higher levels of Ki-67 are linked to worse prognosis.
After surgery, many women will have one or more adjuvant treatments. Adjuvant treatments, such as:
are used to get rid of any cancer cells that might have been left behind after surgery. Adjuvant treatments also can lower the risk of the cancer coming back.
When deciding which adjuvant treatments would help a woman, doctors weigh the risks and side effects of each treatment against its benefits. Having a test that would predict whether a woman is likely to benefit from adjuvant chemotherapy would be very helpful. Researchers have been looking for different types of markers that could be the basis for this kind of test.
One test, the Oncotype DX, can help make treatment decisions for post-menopausal women diagnosed with estrogen-receptor-positive early breast cancer that has spread to the lymph nodes. By looking at specific genes in the breast cancer, the Oncotype DX can help predict the likelihood of the cancer coming back. It can also predict whether a woman would benefit from adjuvant hormonal therapy AND chemotherapy, instead of just hormonal therapy alone.
Neither the Oncotype DX nor any other test are perfect at predicting whether or not you'll get any benefit from chemotherapy. Each woman's situation is unique, so you and your doctor will want to consider other factors, such as:
when deciding on whether you'd benefit from chemotherapy. Together, you can make the best treatment decisions for YOU.
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