Featured Research

from universities, journals, and other organizations

New Predictive Tool Can Help Determine Treatment Of Breast Cancer Patients

Date:
September 29, 2008
Source:
Washington University School of Medicine
Summary:
A new predictive measurement, called a PEPI score, could bring good news to many women diagnosed with early stage breast cancer -- a low PEPI (preoperative endocrine prognostic index) score could show that they have little risk of relapse, and can safely avoid chemotherapy after surgery.

A new predictive measurement, called a PEPI score, could bring good news to many women diagnosed with early stage breast cancer — a low PEPI (preoperative endocrine prognostic index) score could show that they have little risk of relapse and can safely avoid chemotherapy after surgery.

For others, a high PEPI score could warn that the risk of relapse after breast surgery is large and indicates that careful follow-up and aggressive therapy may be needed, say researchers at Washington University School of Medicine in St. Louis and collaborating institutions in Europe.

A team led by Matthew Ellis, M.D., Ph.D., a breast-cancer specialist with the Siteman Cancer Center at Washington University and Barnes-Jewish Hospital, developed and validated the PEPI score. Ellis asserts that predictive tools such as this are vital to breast cancer treatment and research.

"At present about 83 percent of patients are cured of breast cancer," he says. "The key is to identify that 83 percent so we can treat them with effective available therapies and focus our research efforts on the 17 percent who are resistant to current treatments."

The PEPI score was derived from tumor characteristics present after women with stage 2 and 3 breast cancer underwent four months of anti-estrogen therapy before having breast surgery. Presurgical anti-estrogen therapy with drugs such as tamoxifen and letrozole can shrink tumors that depend on estrogen for their growth and potentially allow breast-conserving surgery. The majority of breast cancer patients have these estrogen receptor-positive tumors.

"This is a groundbreaking approach to predicting outcomes for patients with hormone receptor-positive breast cancer," says Ellis, the Anheuser-Busch Endowed Professor in Medical Oncology at the School of Medicine. "In essence, we are looking at how tumors respond to anti-estrogen therapy in the short term to predict how well patients will do in the long term.

The PEPI score takes into account four factors present after presurgical anti-estrogen therapy to estimate risk of relapse and survival rates:

  • the size of the breast tumor,
  • whether cancer is present in nearby lymph nodes,
  • how fast tumor cells are multiplying, and
  • whether tumors lose their estrogen receptors.

The researchers found that women with a PEPI score of 0 had almost no risk of cancer recurrence during the five-year follow-up. They could safely avoid taking chemotherapeutic agents after surgery.

"Chemotherapy after breast surgery is used to reduce relapse risk," Ellis says. "Since the rate of relapse in this group is so low, there is little chance that chemotherapy would be helpful to them."

Women with PEPI scores of 4 or above are at very high risk of having their cancer return and should be given all appropriate post-surgical treatments, according to the report. Those with PEPI scores of 1 to 3 fall in an intermediate group, and more studies are needed to determine the best courses of treatment for them, Ellis says.

PEPI scores are derived by assigning a certain number of points to each of the four PEPI factors. Patients with a PEPI score of 0 had a tumor that shrank to stage 0 or 1 or 2A after anti-estrogen therapy, and no cancer was present in lymph nodes. Their tumors also had low levels of a marker of cell growth and remained estrogen-receptor positive after anti-estrogen therapy.

Women with PEPI scores of 4 or more tended to have larger tumors after anti-estrogen therapy and were also likely to have cancer in lymph nodes, high rates of tumor cell growth and tumors that lost their estrogen receptors. These women had about a 50 percent chance of relapse.

An intermediate group with PEPI scores of 1 to 3 had either large tumors but few of the other dangerous markers or small tumors with more of the dangerous markers.

Further study will be needed to determine the relapse risk for this group as well as to validate the PEPI model for predicting breast cancer death. Preliminary data showed that, as expected, women with low PEPI scores survived longer on average than those with high PEPI scores.

"We're entering a completely different diagnostic situation now, where we can profile stage 2 and 3 tumors after anti-estrogen therapy and use the results to guide the next treatment steps," Ellis says. "Further research will determine whether a similar approach can predict outcomes in women with earlier stage breast cancers."


Story Source:

The above story is based on materials provided by Washington University School of Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Ellis MJ, Tao Y, Luo J, A'Hern R, Evans DB, Bhatnagar AS, Chaudri Ross, HA, von Kameke A, Miller WR, Smith I, Eiermann W, Dowsett M. Outcome Prediction for Estrogen Receptor%u2013Positive Breast Cancer Based on Postneoadjuvant Endocrine Therapy Tumor Characteristics. Journal of the National Cancer Institute, Sept. 23, 2008

Cite This Page:

Washington University School of Medicine. "New Predictive Tool Can Help Determine Treatment Of Breast Cancer Patients." ScienceDaily. ScienceDaily, 29 September 2008. <www.sciencedaily.com/releases/2008/09/080923164642.htm>.
Washington University School of Medicine. (2008, September 29). New Predictive Tool Can Help Determine Treatment Of Breast Cancer Patients. ScienceDaily. Retrieved August 21, 2014 from www.sciencedaily.com/releases/2008/09/080923164642.htm
Washington University School of Medicine. "New Predictive Tool Can Help Determine Treatment Of Breast Cancer Patients." ScienceDaily. www.sciencedaily.com/releases/2008/09/080923164642.htm (accessed August 21, 2014).

Share This




More Health & Medicine News

Thursday, August 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Possible Ebola Patient in Isolation at California Hospital

Possible Ebola Patient in Isolation at California Hospital

Reuters - US Online Video (Aug. 20, 2014) — A patient who may have been exposed to the Ebola virus is in isolation at the Kaiser Permanente South Sacramento Medical Center. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Raw: World's Oldest Man Lives in Japan

Raw: World's Oldest Man Lives in Japan

AP (Aug. 20, 2014) — A 111-year-old Japanese was certified as the world's oldest man by Guinness World Records on Wednesday. Sakari Momoi, a native of Fukushima in northern Japan, was given a certificate at a hospital in Tokyo. (Aug. 20) Video provided by AP
Powered by NewsLook.com
Do More Wedding Guests Make A Happier Marriage?

Do More Wedding Guests Make A Happier Marriage?

Newsy (Aug. 20, 2014) — A new study found couples who had at least 150 guests at their weddings were more likely to report being happy in their marriages. Video provided by Newsy
Powered by NewsLook.com
Ebola-Hit Sierra Leone's Freetown a City on Edge

Ebola-Hit Sierra Leone's Freetown a City on Edge

AFP (Aug. 19, 2014) — Residents of Sierra Leone's capital voice their fears as the Ebola virus sweeps through west Africa. Duration: 00:56 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins