Features of treatment of the breast cancer patients with disseminated tumor cells and overproduction of tumor necrosis factor in bone marrow
A. Zhylchuk1, Yu. Kudryavets2
1Rivne Regional Oncological Hospital, Rivne, Ukraine
2R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, NAS of Ukraine, Kyiv, Ukraine
Introduction: One of the main problems of oncology is the low efficiency of treatment against disseminated forms of neoplastic process — recurrence and metastasis, which is the main cause of high mortality among cancer patients. The important characteristic of disseminated cancer is the presence of tumor cells in the bone marrow (BM), as in many cases the use of high-dose chemotherapy by accepted protocols is inefficient. The goal was to prevent cancer progression and bone metastasis in breast cancer patients with disseminated tumor cells (DTC) in BM and with elevated levels of TNF in BM using modified schemes of polychemotherapy with bisphosphonates. Patients and Methods: This research was carried out during the therapy of 119 patients with breast cancer in a disease stage T1–4N1–2M0. DTCs and TNF were analyzed in BM of all patients before therapy. The patients with DTCs in BM were divided into 2 groups. Group 1 (n = 20) underwent preoperative therapy according to AC (doxorubicin + cyclophosphamide) scheme. Group 2 (n = 27) received preoperative therapy in compliance with AC — Paclitaxel scheme and + Zoledronic acid (Zometa) in the postoperative period. Patients with high level (more than 150 pg/ml, n = 53) TNF in BM were divided into the same two therapeutic groups (n = 27 and n = 26). Results: It was found that DTC had been present in 47 patients (39.4%). Proportion of patients who were in 36 months remission was about the same in both groups — with DTC in BM or without it (59.5% and 60.2% respectively). The efficacy of treatment schemes AC → P + Zometa schemes vs. 48.9% in AC group. A similar pattern is evident while comparing the same therapeutic patterns for patients with high level of TNF in BM. Disease progression was observed in 25.9% of patients with AC → P + Zometa schemes vs. 73.1% in AC group. Conclusion: Presence of DTC and TNF in the bone marrow indicates a high risk of disease progression for patients with breast cancer. Preoperative polychemotherapy according to the scheme of AC → P followed by Zometa in the postoperative period for patients with DTC in BM and high TNF levels in BM is more effective in comparison with AC scheme.
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