Marker-Directed Monitoring for Breast Cancer

Recruiting in Palo Alto (17 mi)

+662 other locations

Overseen by Melissa Accordino

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: SWOG Cancer Research Network

Must be taking: Endocrine therapy

Disqualifiers: Cirrhosis, Untreated B12 deficiency, Thalassemia, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial studies if using blood tests to decide when to do scans is as effective as the standard way for monitoring patients with a specific type of breast cancer that has spread. The blood tests act like an early warning system for cancer activity.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you must be receiving or plan to receive first-line systemic treatment for metastatic breast cancer, which may include endocrine therapy, targeted therapy, or chemotherapy.

What data supports the effectiveness of the treatment Serum Tumor Marker directed disease monitoring for breast cancer?

Research suggests that using serum tumor markers can help monitor treatment and detect cancer recurrence, potentially at a lower cost than traditional methods. However, while they can provide useful information for monitoring, they are not yet proven to be cost-effective or reliable enough to guide treatment decisions on their own. ^{1 2 3 4 5}

Is Marker-Directed Monitoring for Breast Cancer safe for humans?

The research on antibody-drug conjugates (ADCs), which are similar in concept to marker-directed monitoring, shows they are generally safe but can cause side effects like low blood cell counts, nausea, and heart issues. These side effects are usually manageable with dose adjustments and supportive care. ^{6 7 8 9 10}

How does the treatment 'Serum Tumor Marker directed disease monitoring' differ from other treatments for breast cancer?

This treatment is unique because it uses serum tumor markers (proteins found in the blood) to monitor the progression of breast cancer and the patient's response to treatment, offering a noninvasive and potentially earlier indication of disease changes compared to traditional imaging methods. ^{11 12 13 14 15}

Research Team

Melissa Accordino

Principal Investigator

SWOG Cancer Research Network

Eligibility Criteria

This trial is for adults with hormone receptor positive, HER2 negative metastatic breast cancer who are starting or receiving first-line systemic treatment. They must not be pregnant, have had other cancers (except certain skin/cervical cancers) in the last five years, or conditions like cirrhosis that affect tumor marker levels. Participants need decision-making capacity and can't be in another first-line treatment trial.

Inclusion Criteria

I am not in, nor planning to join, another first-line treatment trial for my metastatic breast cancer.

Patients must not be pregnant

I have not had systemic therapy for my metastatic breast cancer, except my current treatment.

Exclusion Criteria

I have cancer that has spread to the lining of my brain.

I have cirrhosis, untreated B12 deficiency, thalassemia, or sickle cell anemia.

Patients must not have known progression since registration to step 1

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Patients undergo either usual care disease monitoring or serum tumor marker directed disease monitoring (STMDDM) for up to 312 weeks

312 weeks

Every 4-12 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

102 weeks

Treatment Details

Interventions

• Serum Tumor Marker directed disease monitoring (Behavioural Intervention)
• Usual care disease monitoring (Behavioural Intervention)

Trial Overview The study compares usual care disease monitoring to serum tumor marker directed monitoring to see if using blood markers to decide when to do scans is as effective for patients with advanced breast cancer. It includes quality-of-life assessments and anxiety questionnaires.

Participant Groups

Group I: Arm II (serum tumor directed disease monitoring) Experimental Treatment 3 Interventions

Patients undergo disease specific serum tumor marker evaluation (CEA and either CA 15-3 or CA 27.29, whichever were tested at Step 1 Registration and Step 2 Registration) every 4-8 weeks (starting from randomization) without imaging until an elevation of at least one disease specific STM. In the event of an elevated STM, the patient will have imaging within 4 weeks to evaluate for disease progression. Patients continue with STMDDM for up to 312 weeks in the absence of disease progression.

Group II: Arm I (usual care) Active Control 3 Interventions

Patients will have imaging studies (modality and frequency per treating physician, however at a minimum frequency of every 12 weeks) alone or in conjunction with STMs (frequency determined by treating physician). Patients will continue with usual care disease monitoring for up to 312 weeks in the absence of disease progression.

Who Is Running the Clinical Trial?

SWOG Cancer Research Network

Lead Sponsor

Trials

403

Recruited

267,000+

Dr. Charles D. Blanke

SWOG Cancer Research Network

Chief Executive Officer since 2012

MD from Oregon Health & Science University

Dr. Dawn Hershman

SWOG Cancer Research Network

Chief Medical Officer since 2020

MD from Columbia University

Southwest Oncology Group

Lead Sponsor

Trials

389

Recruited

260,000+

Dr. Lyudmila Bazhenova

Southwest Oncology Group

Chief Medical Officer since 2021

MD from University of California, San Diego

Dr. Richard Schilsky

Southwest Oncology Group

Chief Executive Officer since 2013

MD from University of California, San Diego

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Dr. Douglas R. Lowy

National Cancer Institute (NCI)

Chief Executive Officer since 2023

MD from New York University School of Medicine

Dr. Monica Bertagnolli

National Cancer Institute (NCI)

Chief Medical Officer since 2022

MD from Harvard Medical School

Findings from Research

The study found a 125% increase in tumour marker requests over five years, indicating a growing reliance on these tests in cancer management, but many requests were inappropriate, such as being made for the wrong sex or before a cancer diagnosis.

Out of 34 case notes reviewed, many tumour markers were measured before necessary biopsies, leading to potentially misleading results, as some patients with normal markers still had malignancies, while others with raised markers had normal biopsies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tumour markers: their use and misuse by clinicians. McGinley, PJ., Kilpatrick, ES.[2015]

Using serum markers to assess therapeutic response in patients with advanced breast cancer could provide equivalent quality assessments compared to traditional methods, but at a lower cost.

The potential cost savings from using serum markers are significant enough to warrant the initiation of a randomized controlled trial to further investigate their efficacy and practicality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Potential for cost economies in guiding therapy in patients with metastatic breast cancer. Robertson, JF., Whynes, DK., Dixon, A., et al.[2019]

Antibody-drug conjugates (ADCs) are a promising treatment for breast cancer, effectively delivering cytotoxic drugs directly to tumors while minimizing systemic toxicity, making them generally well tolerated.

Despite their benefits, ADCs can cause predictable side effects such as neutropenia and nausea, which require careful monitoring and management to prevent treatment interruptions or dose reductions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Toxicity profile of antibody-drug conjugates in breast cancer: practical considerations. D'Arienzo, A., Verrazzo, A., Pagliuca, M., et al.[2023]

Antibody-drug conjugates (ADCs) are a promising cancer treatment that combines targeted monoclonal antibodies with cytotoxic agents to deliver drugs directly to cancer cells, minimizing harm to healthy cells.

Despite their targeted approach, ADCs can still cause adverse events due to early payload release or target expression in normal cells, highlighting the need for careful monitoring and dose adjustments to optimize their safety and effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strategies for Mitigating Antibody-Drug Conjugate Related Adverse Events for Precision Therapy. Gouda, MA., Subbiah, V.[2022]

Serum tumor markers are a cost-effective and noninvasive method for monitoring breast cancer patients, providing insights into disease presence and progression, although their effectiveness in therapy response evaluation remains debated among experts.

Recent advancements in imaging technology, like hybrid PET-CT scans, can detect early cancer lesions that may cause elevated serum tumor marker levels, suggesting that these markers can guide further diagnostic procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Usefulness of traditional serum biomarkers for management of breast cancer patients. Mirabelli, P., Incoronato, M.[2021]

Current clinical practice primarily uses CA 15.3, CEA, and cytokeratins as serum markers for breast cancer, but these markers are not sensitive enough for early detection of primary breast cancer.

Tumor markers are effective for diagnosing recurrent disease and monitoring treatment response, offering advantages over traditional imaging methods, though further randomized studies are needed to confirm any survival benefits from early interventions based on marker elevation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Circulating tumour markers in breast cancer. Seregni, E., Coli, A., Mazzucca, N.[2018]

In a study of 39,650 early-stage breast cancer survivors, 42% underwent tumor marker assessments, averaging 5.7 tests over two years, despite guidelines discouraging routine use.

Patients who received tumor marker tests incurred approximately 29% higher medical costs compared to those who did not, indicating a significant financial impact associated with their use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tumor marker usage and medical care costs among older early-stage breast cancer survivors. Ramsey, SD., Henry, NL., Gralow, JR., et al.[2022]

Breast cancer is a complex disease with various subtypes, making it challenging to predict patient outcomes, highlighting the need for effective biomarkers to guide treatment decisions.

Recent studies suggest that circulating proteins obtained through liquid biopsy could serve as valuable, non-invasive biomarkers for early diagnosis, treatment adjustment, and monitoring disease progression in breast cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Circulating proteins as predictive and prognostic biomarkers in breast cancer. Veyssière, H., Bidet, Y., Penault-Llorca, F., et al.[2023]

Serum tumor markers like CA 15-3 and CEA are not recommended for screening or diagnosing breast cancer due to their low sensitivity, but they can indicate recurrence 3-6 months earlier than traditional methods in about 40-50% of patients.

While tumor markers can monitor treatment response in 70-80% of metastatic breast cancer patients, their inconsistent results and the need for confirmation through imaging limit their routine clinical use, highlighting the need for improved assays and evaluation of newer markers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Considerations in rational use of tumor markers in breast carcinoma]. Crombach, G.[2015]

References

1. England pubmed.ncbi.nlm.nih.gov

Serum tumor markers in patients with breast cancer. [2015]

2. Netherlands pubmed.ncbi.nlm.nih.gov

[Application of tumour markers in clinical practice]. [2015]

3. England pubmed.ncbi.nlm.nih.gov

Serum tumor markers for patient monitoring: a case-oriented approach illustrated with carcinoembryonic antigen. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Tumour markers: their use and misuse by clinicians. [2015]

5. England pubmed.ncbi.nlm.nih.gov

Potential for cost economies in guiding therapy in patients with metastatic breast cancer. [2019]

6. England pubmed.ncbi.nlm.nih.gov

Toxicity profile of antibody-drug conjugates in breast cancer: practical considerations. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Strategies for Mitigating Antibody-Drug Conjugate Related Adverse Events for Precision Therapy. [2022]

8. China pubmed.ncbi.nlm.nih.gov

[Chinese expert consensus of antibody-drug conjugate toxicity management for breast cancer]. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Antibody drug conjugates for treatment of breast cancer: Novel targets and diverse approaches in ADC design. [2018]

10. Japan pubmed.ncbi.nlm.nih.gov

Identification of a novel inhibitor of triple-negative breast cancer cell growth by screening of a small-molecule library. [2014]

11. United States pubmed.ncbi.nlm.nih.gov

Usefulness of traditional serum biomarkers for management of breast cancer patients. [2021]

12. Germany pubmed.ncbi.nlm.nih.gov

Circulating tumour markers in breast cancer. [2018]

13. United States pubmed.ncbi.nlm.nih.gov

Tumor marker usage and medical care costs among older early-stage breast cancer survivors. [2022]

14. England pubmed.ncbi.nlm.nih.gov

Circulating proteins as predictive and prognostic biomarkers in breast cancer. [2023]

15. Switzerland pubmed.ncbi.nlm.nih.gov

[Considerations in rational use of tumor markers in breast carcinoma]. [2015]