MEDICAL DEVICE INNOVATION - Medical Device Daily

More documents

Recommendations

Info

92 New breast cancer marker may predict likelihood of spreading MEDICAL DEVICE INNOVATION 2010 By AMANDA PEDERSEN Medical Device Daily Staff Writer If cancer doctors had a crystal ball they could peer into and know whether or not a particular patient’s cancer will spread, it would take the guesswork out of choosing which treatment option is best. For now, the next-best thing may be the discovery of a new breast cancer marker associated with metastasis that may lead to the development of a tissue test to predict the likelihood of metastasis via the bloodstream. In a small, case-control study, researchers at NewYork- Presbyterian Hospital/Weill Cornell Medical Center (New York) have linked the density of the new marker, called Tumor Microenvironment of Metastasis (TMEM), with the development of distant organ metastasis via the bloodstream. According to the authors, that is the most common cause of death from breast cancer. They also noted that about 40% of breast cancer patients relapse and develop metastatic disease and that roughly 40,000 women die of metastatic breast cancer every year. “Currently, anyone with a breast cancer diagnosis fears the worst – that the cancer will spread and threaten their lives. A tissue test for metastatic risk could alleviate those worries, and prevent toxic and costly measures like radiation and chemotherapy,” says senior author Joan Jones, MD, professor of clinical pathology and laboratory medicine at Weill Cornell Medical College and director of Anatomic Pathology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. In the study, investigators performed a retrospective analysis of tissue samples from 30 patients with invasive ductal carcinoma of the breast who developed systemic, distant-organ metastases. These samples were compared to matched controls that had breast cancer that did not spread. The samples were compared by size of the tumor, differentiation of the tumor (how it looks under a microscope compared to normal breast tissue), and other factors, Jones told Medical Device Daily. All patients were female and underwent primary resection of their breast cancer at NewYork-Presbyterian Hospital/Weill Cornell Medical Center between 1992 and 2003. The researchers found that TMEM density was more than double in the group of patients who developed systematic metastases compared with the patients with only localized breast cancer. Also, they found that in well-differentiated tumors, where the outcome is generally good, the TMEM count was low. “If patients can be better classified as either low risk or high risk for metastasis, therapies can be custom tailored to patients, preventing over-treatment or under-treatment of the disease,” said first author Brian Robinson, MD, resident in Anatomic Pathology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Integrative Cancer Biology Program of the National Cancer Institute funded the study. Because the analysis was done on a very select group of patients, Jones said the findings would have to be validated in a larger sample group before the test could be rolled out. “What we need to do next, before we could make this a more generally applicable test, is we need to do a population study . . . using a much broader range of subjects,” Jones said. “So we’re trying to get funding to do that and get a bunch more people – a few hundred, lets say – so we can see if what we observed in these select patient samples [can be made] more general.” The Weill Cornell investigators set out to build on previous research by co-author John Condeelis, PhD, of the Albert Einstein College of Medicine (Bronx, New York). Working in animal models, he identified a link between blood-borne or systemic metastasis and a three-part association between invasive carcinoma cells, perivascular white blood cells (macrophages) and the endothelial cells that line vessel walls. To confirm this finding in humans, Jones and Robinson developed a triple immunostain for human breast cancer samples that simultaneously labels the three cell types that together they named TMEM. “What made us try this in the human samples is what had been observed in some of the animal models of breast cancer,” Jones said. In some of the animal models scientists have been able to actually look at the tumor in the live animal and watch cells move in the vessels. Jones admitted that the fact that this test did seem to work in the case-control study was somewhat surprising to her. “This is a very novel way for a pathologist like me to look at tissue,” she tells MDD. “It’s not intuitive, it is kind of a new concept.” Jones said that before she and her colleagues did the case-control study, they had analyzed “a bunch of breast cancers” and stained them and looked for these TMEM structures and counted them. In those tumors where the outcome was moderate or poor, the researchers counted a higher number of the TMEMs. “That encouraged us to think, ‘well maybe this means something,’” she said. Likewise, in the case-control study, the cancers that metastasized had a higher number of TMEMs than the cancers that did not spread. “It did seem to have some reflection of that tumor’s ability to get into blood vessels,” Jones said. Notably, Jones said TMEM density was associated with the development of distant-organ metastasis, independent of lymph node status and tumor grade. “Traditionally, the likelihood of breast cancer metastasis is estimated based on tumor size, tumor differentiation – how similar or dissimilar the tumor is compared to nor- To subscribe, please call MEDICAL DEVICE DAILY Customer Service at (800) 888-3912; outside the U.S. and Canada, call (404) 262-5547. Copyright © 2010 AHC Media LLC. Reproduction is strictly prohibited.
MEDICAL DEVICE INNOVATION 2010 93 mal breast tissue – and whether it has spread to the lymph nodes. While these are useful measures, TMEM density directly reflects the blood-borne mechanism of metastasis, and therefore may prove to be more specific and directly relevant,” Jones said. In addition to validating the findings in a larger sample group, the researchers say they need to identify a threshold TMEM density for metastasis risk, and streamline the process for measuring TMEM. While an estimated 10% to 15% of patients have an aggressive form of the disease that metastasizes within three years after initial diagnosis, metastasis can take 10 years or longer to occur, the authors noted. To decrease the risk for the emergence of metastatic tumors, roughly 80% of breast cancer patients are treated with adjuvant chemotherapy. The clinical benefit is a 3% to 10% increase in 15-year survival, depending upon the age of the patient at diagnosis, according to the study authors. “A lot of patients are getting chemotherapy because there could be some chance that they’re going to metastasize, but they don’t really know what that risk is,” Jones said. Study co-authors include Gabriel Sica, MD, PhD, and Yi- Fang Liu, MD, of NewYork-Presbyterian/Weill Cornell; Thomas Rohan, MD, PhD, of the Department of Epidemiology and Population Health at Albert Einstein College of Medicine; Frank Gertler, PhD, of the Department of Biology, Koch Institute for Integrative Cancer Biology at Massachusetts Institute of Technology (Cambridge); and Condeelis of the Department of Anatomy & Structural Biology, Program in Tumor Microenvironment and Metastasis, Albert Einstein Cancer Center at the Albert Einstein College of Medicine. (This story originally appeared in the April 7, 2009, edition of Medical Device Daily). To subscribe, please call MEDICAL DEVICE DAILY Customer Service at (800) 888-3912; outside the U.S. and Canada, call (404) 262-5547. Copyright © 2010 AHC Media LLC. Reproduction is strictly prohibited.
Page 1 and 2:
MEDICAL DEVICE DAILY MEDICAL DEVIC
Page 3 and 4:
MEDICAL DEVICE INNOVATION 2010 1 AB
Page 5 and 6:
MEDICAL DEVICE INNOVATION 2010 3 Ta
Page 7 and 8:
MEDICAL DEVICE INNOVATION 2010 5 In
Page 9 and 10:
MEDICAL DEVICE INNOVATION 2010 A ti
Page 11 and 12:
MEDICAL DEVICE INNOVATION 2010 9 do
Page 13 and 14:
MEDICAL DEVICE INNOVATION 2010 Hear
Page 15 and 16:
MEDICAL DEVICE INNOVATION 2010 ARS
Page 17 and 18:
MEDICAL DEVICE INNOVATION 2010 15 b
Page 19 and 20:
MEDICAL DEVICE INNOVATION 2010 17 T
Page 21 and 22:
MEDICAL DEVICE INNOVATION 2010 Avan
Page 23 and 24:
MEDICAL DEVICE INNOVATION 2010 Body
Page 25 and 26:
MEDICAL DEVICE INNOVATION 2010 Came
Page 27 and 28:
MEDICAL DEVICE INNOVATION 2010 25 t
Page 29 and 30:
Page 31 and 32:
MEDICAL DEVICE INNOVATION 2010 29 2
Page 33 and 34:
MEDICAL DEVICE INNOVATION 2010 Coru
Page 35 and 36:
MEDICAL DEVICE INNOVATION 2010 33 s
Page 37 and 38:
MEDICAL DEVICE INNOVATION 2010 Surg
Page 39 and 40:
MEDICAL DEVICE INNOVATION 2010 Chee
Page 41 and 42:
Page 43 and 44: MEDICAL DEVICE INNOVATION 2010 Cohe
Page 45 and 46: MEDICAL DEVICE INNOVATION 2010 FDA
Page 47 and 48: MEDICAL DEVICE INNOVATION 2010 45 c
Page 49 and 50: MEDICAL DEVICE INNOVATION 2010 Enfa
Page 51 and 52: MEDICAL DEVICE INNOVATION 2010 Drex
Page 53 and 54: MEDICAL DEVICE INNOVATION 2010 Ekos
Page 55 and 56: MEDICAL DEVICE INNOVATION 2010 53 I
Page 57 and 58: MEDICAL DEVICE INNOVATION 2010 55 w
Page 59 and 60: MEDICAL DEVICE INNOVATION 2010 Exmo
Page 61 and 62: MEDICAL DEVICE INNOVATION 2010 Endo
Page 63 and 64: MEDICAL DEVICE INNOVATION 2010 Broa
Page 65 and 66: MEDICAL DEVICE INNOVATION 2010 Heal
Page 67 and 68: MEDICAL DEVICE INNOVATION 2010 Stud
Page 69 and 70: MEDICAL DEVICE INNOVATION 2010 ExAb
Page 71 and 72: MEDICAL DEVICE INNOVATION 2010 69 J
Page 73 and 74: MEDICAL DEVICE INNOVATION 2010 71 c
Page 75 and 76: MEDICAL DEVICE INNOVATION 2010 Hybr
Page 77 and 78: MEDICAL DEVICE INNOVATION 2010 Tru-
Page 79 and 80: MEDICAL DEVICE INNOVATION 2010 77 L
Page 81 and 82: MEDICAL DEVICE INNOVATION 2010 Lumi
Page 83 and 84: MEDICAL DEVICE INNOVATION 2010 81 t
Page 85 and 86: MEDICAL DEVICE INNOVATION 2010 MTI
Page 87 and 88: MEDICAL DEVICE INNOVATION 2010 Micr
Page 89 and 90: MEDICAL DEVICE INNOVATION 2010 Nano
Page 91 and 92: MEDICAL DEVICE INNOVATION 2010 89 s
Page 93: MEDICAL DEVICE INNOVATION 2010 91 A
Page 97 and 98: MEDICAL DEVICE INNOVATION 2010 NiTi
Page 99 and 100: MEDICAL DEVICE INNOVATION 2010 NMT
Page 101 and 102: MEDICAL DEVICE INNOVATION 2010 Tran
Page 103 and 104: MEDICAL DEVICE INNOVATION 2010 New
Page 105 and 106: MEDICAL DEVICE INNOVATION 2010 Paci
Page 107 and 108: MEDICAL DEVICE INNOVATION 2010 105
Page 111 and 112: MEDICAL DEVICE INNOVATION 2010 Non-
Page 113 and 114: MEDICAL DEVICE INNOVATION 2010 Pros
Page 117 and 118: MEDICAL DEVICE INNOVATION 2010 Sanu
Page 119 and 120: MEDICAL DEVICE INNOVATION 2010 Clos
Page 121 and 122: MEDICAL DEVICE INNOVATION 2010 Once
Page 123 and 124: MEDICAL DEVICE INNOVATION 2010 SFC
Page 125 and 126: MEDICAL DEVICE INNOVATION 2010 Mayo
Page 127 and 128: MEDICAL DEVICE INNOVATION 2010 C-Pu
Page 129 and 130: MEDICAL DEVICE INNOVATION 2010 supe
Page 131 and 132: MEDICAL DEVICE INNOVATION 2010 Syne
Page 135 and 136: MEDICAL DEVICE INNOVATION 2010 Ther
Page 137 and 138: MEDICAL DEVICE INNOVATION 2010 Gold
Page 139 and 140: MEDICAL DEVICE INNOVATION 2010 Nano
Page 143 and 144: MEDICAL DEVICE INNOVATION 2010 Pilo
Page 145 and 146:
MEDICAL DEVICE INNOVATION 2010 US E
Page 147 and 148:
MEDICAL DEVICE INNOVATION 2010 145
Page 149 and 150:
Page 151 and 152:
MEDICAL DEVICE INNOVATION 2010 A ti
Page 153 and 154:
MEDICAL DEVICE INNOVATION 2010 VisE
Page 155 and 156:
MEDICAL DEVICE INNOVATION 2010 New
Page 157:
show all

MEDICAL DEVICE INNOVATION - Medical Device Daily

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?