Appendix, Tumor Markers in Breast and Colorectal Cancer; ASCO, 960517

Original Source
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Tumor Markers in Breast and Colorectal Cancer

POSTED 05.17.1996
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Appendix

Tables

Colorectal Cancer
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1a. CEA is not recommended to be used as a screening test for colorectal cancer

1b. CEA may be ordered preoperatively in patients with colorectal carcinoma if it would assist in staging and surgical treatment planning. Although elevated preoperative CEA (> 5mg/mL) may correlate with poorer prognosis, data are insufficient to support the use of CEA to determine whether to treat a patient with adjuvant therapy.

1c. If resection of liver metastases would be clinically indicated, it is recommended that postoperative serum CEA testing may be performed every 2-3 months in patients with stage II or III disease for > 2years after diagnosis. An elevated CEA, if confirmed by retesting, warrants further evaluation for metatstatic disease but does not justify the institution of adjuvant therapy or systemic therapy for presumed metastatic disease.
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1d. Present data are insufficient to recommend routine use of the serum CEA alone for monitoring response to treatment. If no other simple test is available to indicate a response, CEA should be measured at the start of treatment for metastatic disease, and every 2 to 3 months during active treatment. Two values above baseline are adequate to document progressive disease even in the absence of corroborating radiographs. CEA is regarded as the marker of choice for monitoring colorectal cancer.

2. Present data are insufficient to recommend LASA for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.
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3. Present data are insufficient to recommend CA 19-9 for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.

4a. Present data are insufficient to recommend DNA flow cytometrically derived ploidy (DNA index) for the management of colorectal cancer.

4b. Present data are insufficient to recommend DNA flow cytometric proliferation analysis (% S phase and related analyses) for the management of colorectal cancer.
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5. Present data are insufficient to recommend the use of p53 expression or mutation for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.

6. Present data are insufficient to recommend the use of the ras oncogene for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.
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Breast Cancer

1a. Present data are insufficient to recommend CA 15-3 for screening, diagnosis, staging, or surveillance following primary treatment. Although an increasing CA 15-3 level can detect recurrence following primary treatment, the clinical benefit is not established; therefore, it cannot be recommended.
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1b. Present data are insufficient to recommend routine use of CA 15-3 alone for monitoring response to treatment. But, in the absence of readily measurable disease, a rising CA 15-3 may be sued to suggest treatment failure.
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2a. CEA is not recommended for screening, diagnosis, staging, or routine surveillance of breast cancer patients following primary therapy.

2b. Routine use of CEA for monitoring response of metatstatic disease to treatment is not recommended. But, in the absence of readily measurable disease, an increasing CEA level may be used to suggest treatment failure.

3a. Estrogen and progesterone receptors are recommended to be measured on every primary breast cancer, and may be measured on metastatic lesions if the results would influence treatment planning.
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3b. In both premenopausal and postmenopausal patients, steroid hormone receptor status may be used to identify patients most likely to benefit from endocrine forms of adjuvant therapy and therapy for recurrent or metastatic disease.

3c. Estrogen and progesterone receptors are relatively weak predictors of long-term relapse and breast cancer related mortality rates, and are not recommended to be used alone to assign a patient to prognostic groupings.
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4a. Present data are insufficient to recommend routinely obtaining DNA flow cytometry-derived estimates of DNA content or S phase in breast tissue.

4b. DNA flow cytometry-derived ploidy are not recommended to be used to assign a patient to prognostic groupings. There is insufficient evidence to recommend the use of S-phase determination for assigning patients to prognostic groupings.

4c. Present data are insufficient to recommend the use of DNA flow cytometry-derived ploidy (DNA index) or flow cytometric measures of proliferation(% S phase and related analysis) for selection of the type of adjuvant therapy to be given.
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4d. Present data are insufficient to recommend the use of DNA flow cytometry-derived information to select among different treatment options of metastatic disease.

5. Present data are insufficient to recommend the use of c-erbB-2 (HER-2/neu) gene amplification or overexpression for management of patients with breast cancer.
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6. Present data are insufficient to recommend use of p53 measurements for management of patients with breast cancer.
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7. Present data are insufficient to recommend use of cathepsin-D measurements for management of patients with breast cancer.
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