Elimination of clonogenic breast cancer cells from human bone marrow: a comparison of immunotoxin treatment with chemoimmunoseparation using 4-hydroperoxycyclophosphamide, monoclonal antibodies, and magnetic microspheres

Article Abstract:

One of the factors that limits the dose of chemotherapy which can be administered to a cancer patient is bone marrow toxicity. Patients with advanced cancer who might benefit from higher doses of chemotherapy may be given bone marrow transplants to replace the marrow ablated by the chemotherapeutic treatment. The best protocol, of course, is to remove bone marrow from the patient prior to chemotherapy and replace it afterward, thus eliminating the problem of tissue rejection as well as the potentially fatal graft-versus-host reaction. This method, called autologous bone marrow transplantation, may permit women with advanced breast cancer to receive more effective chemotherapeutic regimens. However, if the bone marrow itself contains metastatic cancer cells, then the procedure is doomed, since the transplantation will return untreated cancer cells to the patient's body. Unfortunately, bone marrow is a common site for metastases among women with breast cancer. One possible method of circumventing this problem is selective treatment of the bone marrow to remove or destroy the breast cancer cells. The authors compare two methods by which breast cancer cells might be removed from a bone marrow specimen. In their preliminary study, these researchers used an experimental method in which known numbers of cultured breast cancer cells were mixed with specimens of bone marrow. One of the cancer purging methods utilized antibodies attached to poisons to recognize breast cancer cells. The other method utilized a combination of chemical treatment and antibodies attached to magnetic beads. In contrast with the toxic antibodies, the magnetic spheres could be used to remove the cancer cells from the marrow mixture. The results indicate that the use of toxic antibodies (immunotoxins) left the normal bone marrow cells relatively unharmed. However, not all the breast cancer cells were destroyed by this method. In contrast, the combination of chemical treatment and magnetic microsphere separation was more effective at eliminating the cancer cells, but was more toxic for the normal bone marrow cells. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Metastasis, Cancer metastasis

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Postoperative follow-up of patients with early breast cancer: patterns of care among clinical oncologists and a review of the literature

Article Abstract:

Women who have been treated for early breast cancer are at greater risk than the general population for recurrence. However, there is no universally agreed-upon procedure for monitoring the health of women who have been treated for early breast cancer. Should follow-up be limited to regular examination of the breast? Should examination include scans for metastatic disease? Should follow-up include the evaluation of laboratory data which might flag an early recurrence but which is also likely to result in numerous false alarms? To determine the opinions of oncologists on the appropriate follow-up of patients with breast cancer, survey questionnaires were mailed to 197 specialists in the Southeastern US. Eighty oncologists responded. A yearly mammogram was recommended by 95 percent of the physicians responding. This should not be surprising, as the mammogram is the one diagnostic tool which is most clearly associated with improved outcomes. While the consensus on some other diagnostic methods was not so complete, it was possible to tabulate a series of recommendations for follow-up. These include: a yearly mammogram for the life of the patient, a physical exam every three months for the first five years and every 12 months thereafter, and blood count and chemistry lab tests every 6 to 12 months and every 12 months after five years. A chest X-ray every 6 to 12 months and yearly after five years is recommended as well. Liver scans and tests for carcinoembryonic antigen, which may detect metastatic disease, are not recommended. Regular bone scans are not recommended either, but high-risk patients might be given a single bone scan to serve as a possible baseline reference in the future. Further research should determine both the effectiveness of follow-up procedures and the efficiency and cost-benefit ratios of the procedures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surveys, Oncologists

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