Marker Helps Identify Most Aggressive Metastasized Breast Tumors

VBCC - January 2013, Volume 4, No 1 - ASH Annual Meeting
Rosemary Frei, MSc

Boston, MA—Researchers believe they are closing in on a better way to identify breast cancers that are particularly dangerous and therefore require more aggressive therapy.

High levels of the proliferation marker Ki-67 in axillary lymph node metastases from a primary breast tumor are associated with reduced survival, according to a study presented at the American Society for Clinical Pathology’s 2012 meeting.

“This is the first indication for us that a tumor with high proliferative activity and that has metastasized behaves much worse than one with low proliferative activity. Nobody has shown this before,” said lead investigator Ossama Tawfik, MD, PhD, Vice Chairman for Education and Outreach, and Director of Anatomic and Surgical Pathology, University of Kansas Hospital, Kansas City. “We’re trying to get closer to identifying in a clinical way which tumor is going to behave nastier or nicer, so each can be treated with appropriate therapy.”

Dr Tawfik and his colleagues sought to solidify previous research that indicates that Ki-67 is a robust prognostic marker for breast cancer survival.

The team reviewed the outcomes and expression of Ki-67 and other markers in 103 patients (average age, 54.5 years) with primary breast cancers and axillary lymph node metastases. Overall, 17 cancers were Scarff-Bloom-Richardson grade I, 32 were grade II, and 54 were grade III. The average tumor size was 3.3 cm, and 86% of the tumors were ductal.

Expression of Ki-67 correlated with epidermal growth factor receptor (EGFR), p53, HER2 status, and tumor grade. Furthermore, there was an association between primary and lymph node Ki-67 expression and the frequency and the number of positive nodes.

There was no difference in overall survival (OS) in patients whose primary tumor had Ki-67 levels below or above 10%. However, those with lymph nodes with Ki-67 expression <10% had significantly better OS.

The majority of patients whose primary tumors had a Ki-67 expression of <10% also had lymph nodes with a low level of Ki-67 expression, and they had relatively favorable survival rates. The converse was also true, except the 12 patients with Ki-67 expression that was ≥10% in the primary tumor who had Ki-67 expression of <10% in the lymph nodes; those women had relatively better survival.

Other markers predictive of OS were progesterone receptor (PgR) ≥10% in the primary tumor; EGFR ≥10% in the primary tumor; and PgR ≥1%, 5%, and 10% in the lymph nodes. However, a multivariate analysis showed that only Ki-67 ≥10% expression in the lymph nodes was a statistically significant predictor of OS.

“Simply put, the other markers also appear to predict overall survival. But at the end of the day, only Ki-67 had the most power,” coinvestigator Bruce Kimler, PhD, Associate Director, Breast Cancer Prevention Center, University of Kansas Hospital and Medical Pavilion, Westwood, KS, told Value-Based Cancer Care.

Related Items
Poor Pregnancy Outcomes Seen in Women with Childhood-Onset SLE
Rosemary Frei, MSc
VBCR - April 2016, Vol 5, No 2 published on May 23, 2016 in Canadian Rheumatology Association Annual Meeting
Addressing Undertreatment of Patients with Gout Using EMR Data
Rosemary Frei, MSc
VBCR - April 2016, Vol 5, No 2 published on May 11, 2016 in Canadian Rheumatology Association Annual Meeting
Six-Month OBSErve Study Results Indicate Positive Effects of Belimumab in SLE
Rosemary Frei, MSc
VBCR - April 2016, Vol 5, No 2 published on May 8, 2016 in Canadian Rheumatology Association Annual Meeting
Improvements Needed in Access to Timely Quality Care
Rosemary Frei, MSc
VBCR - April 2016, Vol 5, No 2 published on May 7, 2016 in Canadian Rheumatology Association Annual Meeting
Orthotics Reduce Foot Pain in Juvenile Idiopathic Arthritis
Rosemary Frei, MSc
VBCR - April 2016, Vol 5, No 2 published on May 4, 2016 in Juvenile Idiopathic Arthritis
Biosimilar Infliximab Recommended for Approval
Rosemary Frei, MSc
VBCR - February 2016, Vol 5, No 1 published on March 15, 2016 in FDA Approvals, News & Updates
Early Response to Abatacept Detectable by Sophisticated Ultrasound
Rosemary Frei, MSc
VBCR - February 2016, Vol 5, No 1 published on March 15, 2016 in Rheumatoid Arthritis
Updated Recommendations for Pharmacologic Treatment of Patients with Psoriatic Arthritis
Rosemary Frei, MSc
VBCR - February 2016, Vol 5, No 1 published on March 15, 2016 in Psoriatic Arthritis
Two Studies Point to Inadequate Evidence Supporting Many FDA Drug Approvals
Rosemary Frei, MSc
VBCC - December 2015, Vol 6, No 11 published on December 16, 2015 in Health Policy
Multidisciplinary Approach or Aerobic Exercise for Fibromyalgia May Not Be Cost-Effective
Rosemary Frei, MSc
VBCR - December 2015, Volume 4, No 6 published on December 15, 2015 in Fibromyalgia
Last modified: May 28, 2014
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology