Tumor Marker Trial Aims to Ease "Scanxiety" in Breast Cancer

Brittany Lovely
Published: Tuesday, Mar 05, 2019
Melissa K. Accordino, MD, MS

Melissa K. Accordino, MD, MS

Breast surveillance is essential when determining whether or not therapy is beneficial and to avoid toxicity, usual care for patients with metastatic breast cancer includes monitoring of symptoms and cancer burden. However, there is no established optimal frequency of surveillance with imaging and/or serum tumor marker (STM) testing.

. “We also know that disease monitoring can be very stressful on patients and that there can be related anxiety, as patients are nervous about progression.”

Finding the Optimal Frequency

SWOG 1703 will randomize patients with elevated tumor marker levels 1:1 to be monitored with STM alone or usual care. Those in the experimental arm will undergo disease STM evaluation (CA 15-3, CA 27.29 and CAE) every 6 weeks without imaging. In the event of an elevated STM, the patient will have imaging within 4 weeks to evaluate for disease progression. Patients randomized to the SOC arm will undergo scans at least every 12 weeks with or without STMs. The frequency of the scans in the SOC arm will be determined by the treating physician. Patients in both arms will continue with the specified disease monitoring for up to 312 weeks in the absence of disease progression and will complete QoL assessments and anxiety questionnaires (Figure).1

The logic of gathering such data is that it makes sense to monitor patients based on an evidencebased platform, Accordino said. “We would never treat a patient with a drug that we don’t have data for. It is important to get these data and monitor patients in a way that makes sense.”

Figure. SWOG Trial Compares Surveillance Protocols in Metastatic Breast Cancer1

Figure. SWOG Trial Compares Surveillance Protocols in Metastatic Breast Cancer

Changing the Treatment Landscape

Currently, the National Comprehensive Cancer Network (NCCN) guidelines do not have a recommendation for the optimal frequency of monitoring patients with metastatic breast cancer. Frequency of monitoring, the guidelines state, must be balanced with the need to detect progressive disease, avoid unnecessary toxicity, utilize resources effectively, and manage costs of care.2
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