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1 Oncogene Science, Bayer HealthCare, Cambridge, MA 02142.
2 Tufts New England Medical School, Department of Pathology, Boston, MA 02111.
3 Medizinische Fakultaet der Universitaet zu Koeln, D-50931 Koeln, Germany, and Bayer Vital GmbH, D-51368 Leverkusen, Germany.
4 Section of Hematology-Oncology, Pennsylvania State University/Hershey Medical Center, Hershey, PA 17033.
5 Department of Medicine, Veterans Administration Medical Center, Lebanon, PA 17042.
6 Bayer HealthCare, Diagnostics Division, Stoke Court, Stoke Poges, Slough, Berkshire SL2 4LY, United Kingdom.
7 Clinical Biochemistry, University of Oxford, Oxford OX1 2JD, United Kingdom.
aAddress correspondence to this author at: Oncogene Science, Bayer HealthCare, 80 Rogers St., Cambridge, MA 02142. Fax 617-492-8438; e-mail walter.carney.b{at}oncogene.com.
Background: The HER-2/neu oncogene and its p185 receptor protein are indicators of a more aggressive form of breast cancer. HER-2/neu status guides Herceptin therapy, specifically directed to the extracellular domain (ECD) of the HER-2/neu oncoprotein. The HER-2/neu ECD is shed from cancer cells into the circulation and is measurable by immunoassay.
Methods: We performed a systematic review of the peer-reviewed literature on circulating ECD with respect to prevalence, prognosis, prediction of response to therapy, and monitoring of breast cancer.
Results: The prevalence of increased ECD in patients with primary breast cancer varied between 0% and 38% (mean, 18.5%), whereas in metastatic disease the range was from 23% to 80% (mean, 43%). Some women with HER-2/neu-negative tumors by tissue testing develop increased ECD concentrations in metastatic disease. Increased ECD has been correlated with indicators of poor prognosis, e.g., overall survival and disease-free survival. Increased ECD predicts a poor response to hormone therapy and some chemotherapy regimens but can predict improved response to combinations of Herceptin and chemotherapy. Many studies support the value of monitoring ECD during breast cancer progression because serial increases precede the appearance of metastases and longitudinal ECD changes parallel the clinical course of disease.
Conclusions: The monitoring of circulating HER-2/neu ECD provides a tool for assessing prognosis, for predicting response to therapy, and for earlier detection of disease progression and timely intervention with appropriate therapy.
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