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Bone Turnover Markers in Metastatic Breast Cancer

By: Melissa Eng
Posted: Thursday, April 19, 2018

Elevated serum bone biomarkers may predict bone metastasis in patients recently diagnosed with stage II/III breast cancer. This finding is consistent with the understanding that breast cancer cells have an affinity for, and can lie dormant in, the bone microenvironment. Results from this study, led by Janet Brown, MD, MSc, MBBS, of The University of Sheffield, and colleagues, were published in the Journal of the National Cancer Institute.

Serum samples from 872 UK participants enrolled in the multicenter phase III AZURE (BIG01/04) trial were collected to assess levels of P1NP (N–terminal propeptide of type 1 collagen), CTX (C-telopeptide of type 1 collagen), and 1-CTP (pyridinoline cross-linked carboxy-terminal telopeptide of type 1 collagen). These bone turnover biomarkers were measured at baseline and compared with reference standards.

Higher levels of P1NP, CTX, and 1-CTP were associated with significant increased risk of bone metastasis. In fact, baseline values for P1NP, CTX, and 1-CTP were above normal in 27.3%, 30.0%, and 50.5% of patients, respectively. P1NP was likely to be the most sensitive prognostic factor, and CTX was also a sensitive prognostic factor. These three markers appear to be clinically useful; however, their discriminatory ability in this study was thought to be low to moderate.

“There remains a need for a simple blood-based test in early breast cancer that can identify patients with a high risk for development of bone metastasis. Bone turnover markers are easily measured and are worthy of additional investigation in helping to meet this need,” concluded Dr. Brown and colleagues.

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