Table 1.
Summaries from Recent Studies Using Serum Tumor Markers to Monitor for Recurrence in the Adjuvant Setting
| Reference | Patients | Intervention | Outcome |
|---|---|---|---|
| Zervoudis (2007)40 | 358 patients with stage I breast cancer who were disease free after primary treatment. | Clinical exam, mammography, bone scintigraphy, annual CT of the chest and abdomen and multiple serum tumor markers including CEA, CA 15-3, CA 27-29 every 4 months | 18 patients (5%) had increased tumor markers by cutoff values. All of them had negative workup for disease. After 5 years of follow up, 15 of those 18 patients remained free of local recurrence or metastatic disease and the other 3 were lost to follow up. |
| Nicolini (2006)41 | 268 breast cancer patients that were disease free at the start of the study. All stages seem to have been represented and were treated according to guidelines. | Serial serum CEA, CA 15-3, TPA, MCA were measured every 4-6 months. Bone scan, liver ultrasound, and chest x ray were performed every 24-36 months to detect any false negatives. |
There were 19 relapses. Mean lead times between tumor marker elevation and the appearance of disease were between about 3-7 months depending on the tumor marker Sensitivities ranged from 10-68%. 222 patients were found to have tumor marker elevations for non-malignant reasons leading to specificities around 40-70% |
| Valenzuela (2002)42 | 318 patients who were disease-free after primary therapy | CA 15.3 and CEA were measured in serum at each routine follow up visit | 59 patients relapsed, 28 of whom had elevated CA 15-3 levels and 31 of whom did not. 30 patients had false positive elevations of CA 15-3. 17 patients had elevated tumor markers (16 CA 15-3 and 1 CEA) before clinical appearance of metastases. |
| Pedersen (2013)43 | 9 patients with local recurrence and 83 patients who developed distant metastases after primary treatment. Patients who originally presented with distant metastases were excluded. | CA 15-3, CEA, and HER2 were measured. A result was considered positive if above a certain threshold. | None of the patients with local recurrence had elevated serum tumor markers. The most sensitive marker to detect recurrence was CA 15-3 (49.4%). The most sensitive combination was CA 15-3 and CEA (60.2%) In patients with HER2+ tumors, the sensitivity of serum HER2 was 55.6% and 21.2% in patients with HER2 negative tumors |
CEA = carcinoembryonic antigen, MCA = mucin-like carcinoma associated antigen, TPA = tissue polypeptide. Of note, each study used different cutoff values for identifying a patient as positive, though all followed trends in this marker.