Montserrat Daniels

Use of serial carcinoembryonic antigen and CA 15.3 assays in detecting relapses in breast cancer patients

SummaryTo evaluate the utility of CEA and CA 15.3 for early diagnosis of recurrence, serial serum determinations of both antigens were performed in 1023 patients (follow-up: 1–10 years, mean 6.2 years) with primary breast cancer (CA 15.3 in 533 cases) and no evidence of residual disease (NED) after radical treatment (radical mastectomy or simple mastectomy and radiotherapy). 246 patients developed metastases during follow-up.Results: CEA and CA 15.3 were elevated (> 10 ng/ml or > 60 U/ml, respectively) prior to diagnosis in 40% (98/246) and 41% (37/91) of the patients with recurrence, with a lead time of 4.9 ± 2.2 and 4.2 ± 2.3 months, respectively. When patients with locoregional recurrences were excluded, sensitivity improved to 46% (CEA) and 54% (CA 15.3), and to 64% with both tumor markers (CEA and/or CA 15.3). Higher levels of both CEA and CA 15.3 at diagnosis of recurrence, higher sensitivity in early diagnosis of relapse, and a higher lead time were found in ER+ (CEA) or PgR+ patients (CA 15.3) than in those that were negative for these receptors in the primary tumor (p < 0.001). Specificity of the tumor markers was 99% for both CEA (777 NED patients) and for CA 15.3 (444 NED patients), respectively. In conclusion, CEA and CA 15.3 are useful tools for early diagnosis of metastases, mainly in those patients with ER+ or PR+ tumors.

Positive Results of Adjuvant Mitomycin-C in Resected Gastric Cancer: A Randomised Trial on 134 Patients

In order to evaluate the results on successful adjuvant chemotherapy in resected gastric cancer we performed a randomised trial on 134 patients in two arms: a control one with no further treatment after surgery versus a treatment arm given mitomycin-C (MMC), 20 mg/m2 intravenously one day every 6 weeks for four courses, starting before the sixth week after surgery. The median follow-up was 105 months. In the control arm, 49 out of 66 patients died due to recurrence, versus 40 out of 68 patients in treatment arm. Actuarial survival curve was statistically significant (P < 0.025) in favour of the treatment group. Liver metastases were lower in adjuvant group than in the control group (8/68 versus 19/66). Toxicity was mild. Main toxic effects were thrombocytopenia, leukopenia, nausea and vomiting. A pelvis renal cancer as a second malignancy 8 years after gastric cancer was observed. In that particular case MMC was given after surgery. We conclude that adjuvant chemotherapy based on MMC given in the early period after surgery, improves survival rate in gastric cancer resected patients.

Chronic oral etoposide in advanced breast cancer

Chronic oral etoposide has shown activity in some metastatic refractory tumors. To test its activity in previously treated metastatic breast cancer patients, we started a study in 18 consecutive patients given etoposide orally at 50 mg/m2 daily for 21 days. A partial response was observed in 4 of 18 patients (22%); of the responding patients, 3 had visceral metastases and 1 had multiple bone metastases. Leukopenia of grade 3 or 4 was the main hematological toxic effect (23% of patients) and alopecia was the most important nonhematological toxicity. Chronic oral etoposide shows some activity in pretreated patients with metastatic breast cancer, with tolerance being good and toxicity, acceptable. Further studies of this drug given as first-line chemotherapy or in combination with other drugs can establish all its potential activity in this cancer.

Chronic oral etoposide in non-small cell lung carcinoma

25 consecutive inoperable or extended non-small cell lung cancer (NSCLC) patients (19 non-chemotherapy pretreated, 6 non-heavily pretreated) were given oral etoposide, 50 mg/m2/day for 21 successive days, every 4 weeks. 5 partial responses (PR), 9 disease stabilizations were achieved; the overall response rate of 20% (95% confidence interval, 4% to 36%) or 26% in non-pretreated patients. Median survival and PR duration probabilities were 6.7 months and 6.3 months, respectively. Alopecia excepted (96% of patients), non-haematological toxicity was mild. Haematological toxicity WHO grade II+III mainly consisted of leukopenia (28%).

Neoadjuvant and Adjuvant Chemotherapy in the Multidisciplinary Treatment of Oral Cancer Stage III or IV

We performed a retrospective analysis on the effect of initial induction chemotherapy with two courses of cisplatin (each course 120 mg/m2 cisplatin on day 1, then 20 mg/m2 bleomycin (alone) per day for 5 days with 4 weeks between courses) in 75 consecutive patients with advanced cancer of the oral cavity or lip. Further local therapy consisted of surgery or radiation, depending on tumour location. In 18 resected patients adjuvant chemotherapy was added. This consisted of carboplatin, 400 mg/m2 on day 1 then ftorafur alone, 500 mg/m2/day for 30 consecutive days, repeated every month for 4 consecutive months. Among the patients treated in the neoadjuvant setting, complete response was observed in 10 out of 75 patients (13%), and partial response in a further 50 patients (67%) (partial plus complete rate 80%). Of all the patients, 43% in stage III and 26% in stage IV were long-term survivors. Improved survival was observed in surgical patients where adjuvant postoperative chemotherapy was added (P < 0.025). The main toxic effect was vomiting, observed in 71 patients. We noted a low rate of stomatitis (4%) and an important hearing loss (12%). Neoadjuvant and adjuvant cisplatin-based chemotherapy as part of a multidisciplinary approach have a high overall response rate and low toxicity, and should increase survival in cancer of the oral cavity or lip.

111 P - Is age a major factor in breast cancer patients management?

Over 65 years half of new cancers will occur. Nevertheless the elderly are poorly treated and excluded from clinical trials. objective To compare prospectively 420 breast cancer patients (pts) under and over of 65 years. The end-point is the comparison of diagnosis and therapy procedure cost-effectiveness in both groups. Patients and Methods Up to now 100 breast cancer pts have been enrolled on this ongoing trial. Pts pathological clinical, psychological and first treatment characteristics have been recorded and initially compared. Results Mean age of pts was 61 years (range 34–89, 54 pts younger than 65 and 46 older). The analysis of this set of pts did not show statistically significant differences according to their histological grade, stage at diagnosis and hormonal receptors. Eighty pta underwent modified radical mastectomy. Although their mean age (60,2 vs 55,8) was higher than the age of the 20 pts (12 younger than 65, 8 older) who underwent conservative surgery, these differences were not significant. Older patients were significantly less informed about their true diagnosis (p Conclusions This is an interim report of an ongoing prospective trial on 420 breast cancer pts set up to know the pathological clinical psychological and cost–effectiveness profiles of the elderly pts through the comparison with the same issues on younger pts. Some psychological data excepted there are not until now statistically significant differences between both groups.

407 Cure rate after long-term follow-up in head and neck cancer

Between 1973 and 1993, 1355 consecutive head & neck cancer patients were diagnosed and treated with a multidisciplinary approach, and followed until death or until 10 years with no event of disease. Primary patients incidence site were 615 in supraglottis; 280, oral cavity; 254, glottis; 126, hypopharynx; 33, oropharynx, and 47, nasopharynx. Local relapse rate was 20% and node-regional relapse rate other 15%. Distant metastases were observed in 6% of patients, mainly arising from nasopharynx (23%), followed by hypopharynx (11%). Main organ involved was lung (50%). Median follow-up was 10 years (range 4 months to 15 years). Cancer cure was observed after 5 years in glottis, supraglottis, mouth and nasopharynx cancer and after 2 1 2 years in oropharynx and hypopharynx. Highest cure rate was 80% in glottis, followed by 70% in supraglottis, 45% in mouth, 30% in nasopharynx, 25% in oropharynx, and 20% in hypopharynx. Second primary was observed in 7% and a third primary in 0.6% of the patients. Only in 7 patients the second or third primary was seen after 5 year of follow-up. In head & neck cancer, curability is observed after 5 years from definitive therapy in glottis, supraglottis, mouth and nasopharynx, and earlier in oropharynx and hypopharynx. Second and third neoplasia are the main problem after 5 years of follow-up.