Blood test could predict breast cancer's return: study

AFP 

An experimental blood test may be able to predict whether a woman with breast cancer will suffer a relapse months before new tumours would be detectable on scans, researchers said Wednesday.

The technology, described in the journal Science Translational Medicine, works by detecting cancer DNA that circulates in the bloodstream.

While the test is not yet available to the public, and likely will not be for years to come, researchers are hopeful that it could help refine personalized treatments for cancer and perhaps lead scientists further down the path of finding a cure one day.

"We have shown how a simple blood test has the potential to accurately predict which patients will relapse from breast cancer, much earlier than we can currently," said study author Nicholas Turner, team leader in molecular oncology at The Institute of Cancer Research, London.

"Ours in the first study to show that these blood tests could be used to predict relapse," he added.

Scientists took tumour and blood samples from 55 breast cancer patients with early-stage disease. Each of the patients had received chemotherapy and surgery to remove the cancer.

The blood test was administered following surgery and every six months afterward as a follow-up.

Of the 15 women who saw their cancer return, the test accurately predicted that relapse in 12 of them.

The test also detected cancer an average of about eight months earlier than the tumours were visibly detectable on conventional scans.

The technique uses personalized digital polymerase chain reaction (dPCR) tests to track mutations and could be applied to all subtypes of breast cancer, the study said.

Turner said there are some technical challenges to implementing the technology, "but digital PCR is relatively cost-effective and the information that it provides could make a real difference to breast cancer patients."

Breast cancer is diagnosed early in 95 per cent of cases, but knowing whether or not treatment is able to remove all signs of cancer is key to preventing the tumours from returning and spreading elsewhere in the body.

"It will be some years before the test could potentially be available in hospitals, but we hope to bring this date closer by conducting much larger clinical trials starting next year," Turner said.

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Ovarian Cancer: Why Don't More Doctors Use This Life-Extending Technique?

American Council on Science and Health

In America this year, over 21,000 new cases of ovarian cancer are expected, and over 14,000 deaths. 

Once ovarian cancer has spread within the peritoneal cavity or to other organs, long-range survival is rare. However, shorter-term benefits can be obtained via several different chemotherapy regimens and one, essentially abdominal chemotherapy, has been very promising.

So why isn't it used more?

Clinical trials dating back almost 20 years have consistently demonstrated a survival advantage in advanced ovarian cancer treated with this IP/IV (intraperitoneal/intravenous) chemotherapy, as compared with standard IV only chemotherapy. 

In 2006, a large study known as GOG-172 (Gynecologic Oncology Group) demonstrated a 16-month improvement in median overall survival. A new study just published in the Journal of Clinical Oncology confirms the superiority of the combined IP/IV approach. But data collected from six National Comprehensive Cancer Centers Hospitals showed that the combination approach is only being utilized by slightly less than half of patients who are candidates for it.

The study was performed by a multi-center group of researchers led by Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston, and was also published in the Journal of Clinical Oncology. They examined IP/IV chemotherapy use in all patients (823) diagnosed between 2003 and 2012, and evaluated overall survival and treatment-related toxicities in a sample (402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias.

They determined that the use of IP/IV chemotherapy increased, (most likely)  as a result of the 2006 publication of the GOG-172 study, from 0% in 2003 to 50% in 2008, and plateaued thereafter; 43 percent of patients received modified IP/IV regimens at treatment initiation. IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%), compared with IV chemotherapy.

The authors concluded that although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.

An article in the New York Times by Denise Grady on this study and topic speculated on some possible reasons why this beneficial treatment method is being under-utilized: “Experts suggest a variety of reasons that the treatment is so underused: It is harder to administer than intravenous therapy, and some doctors may still doubt its benefits or think it is too toxic. Some may also see it as a drain on their income, because it is time-consuming and uses generic drugs on which oncologists make little money.”

Those possible rationales for not giving late-stage ovarian cancer patients state-of-the-art treatment are quite simply unacceptable. Another word of advice from the Times/Grady article is this: “Patients have to be more proactive and forceful. They should ask if their doctor uses the IP/IV treatment, and if he or she does not, they should seek another doctor.”