Predicting DCIS Breast Cancer Recurrence and Treatment Response with Tumor Markers

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• Understanding DCIS and Treatment Challenges
• Key Tumor Markers for DCIS Prognosis
• Estrogen Receptor Role in Endocrine Therapy
• HER2 Status and Radiotherapy Response
• Ongoing Research and Clinical Trials
• Future of Personalized DCIS Treatment

Understanding DCIS and Treatment Challenges

Ductal carcinoma in situ (DCIS) represents a significant challenge in breast cancer care. Dr. Jack Cuzick, MD, PhD, emphasizes that not all DCIS cases progress to invasive breast cancer. This creates a critical clinical dilemma for oncologists and patients. The primary challenge lies in accurately determining which DCIS lesions have progressive potential and truly require aggressive treatment beyond surgery.

Many DCIS cases might be adequately treated with surgery alone, potentially avoiding the side effects of additional therapies. Dr. Cuzick's research focuses on developing precise tools to make this distinction, aiming to personalize treatment and reduce overtreatment.

Key Tumor Markers for DCIS Prognosis

Dr. Jack Cuzick, MD, PhD, and his team have identified several crucial tumor markers that show promise in predicting DCIS behavior. These biomarkers, already established in invasive breast cancer prognosis, include estrogen receptor (ER) status, progesterone receptor (PR) status, and HER2 (human epidermal growth factor receptor 2) status.

The researchers also investigated Ki-67, a marker that measures tumor proliferation index. According to Dr. Cuzick, these markers provide valuable biological information about the DCIS tumor's characteristics and potential aggressiveness, forming the foundation for more personalized treatment approaches.

Estrogen Receptor Role in Endocrine Therapy

The estrogen receptor status emerges as a critical determinant for endocrine therapy decisions in DCIS. Dr. Jack Cuzick, MD, PhD, confirms that ER-positive DCIS tumors are more likely to benefit from endocrine treatments like tamoxifen or aromatase inhibitors.

This finding helps clinicians identify which patients truly need long-term hormonal therapy to reduce recurrence risk. For ER-negative DCIS patients, endocrine therapy may be unnecessary, sparing them from potential side effects without clinical benefit. This marker-driven approach represents a significant advancement in personalizing DCIS care.

HER2 Status and Radiotherapy Response

HER2 status appears to play a crucial role in predicting response to radiotherapy in DCIS patients. Dr. Jack Cuzick, MD, PhD, reveals compelling research findings, though not yet published, that demonstrate this relationship. The data suggests that HER2-positive DCIS may respond differently to radiation treatment compared to HER2-negative tumors.

This information, presented at scientific medical meetings, could help clinicians determine which patients are most likely to benefit from radiotherapy. It might also identify patients for whom radiotherapy could potentially be avoided, reducing treatment burden and side effects.

Ongoing Research and Clinical Trials

Dr. Jack Cuzick, MD, PhD, is leading extensive research efforts to validate these initial findings. The team is conducting a large clinical trial involving 1,700 breast cancer patients to further investigate these tumor markers. They have already collected biopsy tissue blocks from over a thousand participants, providing a robust dataset for analysis.

This ongoing work aims to establish more definitive guidelines for DCIS treatment based on molecular profiling. The research represents a significant step toward evidence-based, personalized medicine for early-stage breast cancer patients.

Future of Personalized DCIS Treatment

The research conducted by Dr. Jack Cuzick, MD, PhD, points toward a future where DCIS treatment is precisely tailored to individual tumor biology. By using multiple biomarkers including ER, PR, HER2, and Ki-67, clinicians may soon better predict both recurrence risk and treatment response.

This approach could significantly reduce overtreatment, allowing many women with low-risk DCIS to avoid unnecessary radiotherapy and endocrine therapy. As Dr. Cuzick's research progresses, it promises to transform DCIS management from a one-size-fits-all approach to truly personalized cancer care based on molecular characteristics.

Full Transcript

Dr. Anton Titov, MD: You are leading clinical trials that identified specific cancer markers in DCIS, Ductal Carcinoma In Situ, a breast cancer. This marker may predict breast cancer recurrence and what treatments may or may not be given. What can you tell about that research?

Dr. Jack Cuzick, MD: I think this is a very important area of breast cancer research. We do know that not all DCIS progresses to invasive breast cancer. The first challenge is to determine whether this DCIS has progressive potential to invasive breast cancer.

We have to determine if a DCIS patient needs additional treatment. Most DCIS cases can be treated simply by surgery. Radiotherapy may not even be required.

The first cancer markers we looked at were important for invasive breast cancer. We looked at estrogen receptor positivity, progesterone receptor positivity, and HER2 positivity. We also looked at Ki-67 cancer marker as a measure of tumor proliferation index.

Those breast tumor markers are potentially quite useful, but it's still early days of research. We are in the process of doing a large clinical trial based on our first DCIS clinical trial. This is 1,700 breast cancer patients.

We have blocks of breast cancer biopsy tissue on over a thousand patients now, so that work is ongoing. The only work that's been completed has been done for the estrogen receptor and for the HER2 receptor in breast cancer.

There is evidence that HER2 is important for predicting response of breast cancer to radiotherapy. That research result is not published yet, but it has been presented at a scientific medical meeting.

We do believe that estrogen receptors are very important for determining which breast cancer patient needs endocrine therapy.