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dc.contributor.authorSynnestvedt, Marit
dc.contributor.authorBorgen, Elin
dc.contributor.authorWist, Erik
dc.contributor.authorWiedswang, Gro
dc.contributor.authorWeyde, Kjetil
dc.contributor.authorRisberg, Terje
dc.contributor.authorKersten, Christian
dc.contributor.authorMjaaland, Ingvil
dc.contributor.authorVindi, Lise
dc.contributor.authorSchirmer, Cecilie
dc.contributor.authorNesland, Jahn M
dc.contributor.authorNaume, Bjørn
dc.identifier.citationSynnestvedt M, Borgen E, Wist E, Wiedswang G, Weyde K, Risberg T, Kersten C, Mjaaland I, Vindi L, Schirmer C, Nesland JM, Naume B. Disseminated tumor cells as selection marker and monitoring tool for secondary adjuvant treatment in early breast cancer. Descriptive results from an intervention study. BMC Cancer. 2012 Dec 22;12:616.en_US
dc.description.abstractBackground: Presence of disseminated tumor cells (DTCs) in bone marrow (BM) after completion of systemic adjuvant treatment predicts reduced survival in breast cancer. The present study explores the use of DTCs to identify adjuvant insufficiently treated patients to be offered secondary adjuvant treatment intervention, and as a surrogate marker for therapy response. Methods: A total of 1121 patients with pN1-3 or pT1c/T2G2-3pN0-status were enrolled. All had completed primary surgery and received 6 cycles of anthracycline-containing chemotherapy. BM-aspiration was performed 8-12 weeks after chemotherapy (BM1), followed by a second BM-aspiration 6 months later (BM2). DTC-status was determined by morphological evaluation of immunocytochemically detected cytokeratin-positive cells. If DTCs were present at BM2, docetaxel (100 mg/m², 3qw, 6 courses) was administered, followed by DTC-analysis 1 month (BM3) and 13 months (BM4) after the last docetaxel infusion. Results: Clinical follow-up (FU) is still ongoing. Here, the descriptive data from the study are presented. Of 1085 patients with a reported DTC result at both BM1 and BM2, 94 patients (8.7%) were BM1 positive and 83 (7.6%) were BM2 positive. The concordance between BM1 and BM2 was 86.5%. Both at BM1 and BM2 DTC-status was significantly associated with lobular carcinomas (p = 0.02 and p = 0.03, respectively; chi-square). In addition, DTC-status at BM2 was also associated with pN-status (p = 0.009) and pT-status (p = 0.03). At BM1 28.8% and 12.8% of the DTC-positive patients had ≥2 DTCs and ≥3 DTCs, respectively. At BM2, the corresponding frequencies were 47.0% and 25.3%. Of 72 docetaxel-treated patients analyzed at BM3 and/or BM4, only 15 (20.8%) had persistent DTCs. Of 17 patients with ≥3 DTCs before docetaxel treatment, 12 patients turned negative after treatment (70.6%). The change to DTC-negativity was associated with the presence of ductal carcinoma (p = 0.009). Conclusions: After docetaxel treatment, the majority of patients experienced disappearance of DTCs. As this is not a randomized trial, the results can be due to effects of adjuvant (docetaxel/endocrine/trastuzumab) treatment and/or limitations of the methodology. The clinical significance of these results awaits mature FU data, but indicates a possibility for clinical use of DTC-status as a residual disease-monitoring tool and as a surrogate marker of treatment response. Trial registration: Clin Trials Gov NCT00248703.en_US
dc.description.sponsorshipThe study was supported by The Research Council of Norway, South-Eastern Norway Regional Health Authority, The Norwegian Cancer Society, K. G. Jebsen Centre for Breast Cancer Research and Sanofien_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.subjectAnthracyclines / therapeutic useen_US
dc.subjectAntineoplastic Agents / therapeutic useen_US
dc.subjectBone Marrow / pathology*en_US
dc.subjectBreast Neoplasms / diagnosisen_US
dc.subjectBreast Neoplasms / pathology*en_US
dc.subjectBreast Neoplasms / therapyen_US
dc.subjectChemotherapy, Adjuvanten_US
dc.subjectMiddle Ageden_US
dc.subjectNeoplasm, Residualen_US
dc.subjectTreatment Outcomeen_US
dc.titleDisseminated tumor cells as selection marker and monitoring tool for secondary adjuvant treatment in early breast cancer. Descriptive results from an intervention studyen_US
dc.title.alternativeDisseminated tumor cells as selection marker and monitoring tool for secondary adjuvant treatment in early breast cancer. Descriptive results from an intervention studyen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.rights.holder© 2012 Synnestvedt et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citeden_US
dc.source.journalBMC Canceren_US

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Navngivelse 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Navngivelse 4.0 Internasjonal