Bone Metabolic Markers in the Evaluation of Bone Scan Flare Phenomenon in Bone Metastases of Breast Cancer
- 1 January 1999
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Nuclear Medicine
- Vol. 24 (1), 15-20
- https://doi.org/10.1097/00003072-199901000-00004
Abstract
Bone scan flare seriously complicates evaluations of the therapeutic response of bone metastases. The value of bone metabolic markers in monitoring the therapeutic response for bone metastases in breast cancer was assessed. Twenty-three breast cancer patients with bone metastases treated by combined chemotherapy of cyclophosphamide, doxorubicin, and 5-fluorouracil (CAF) were monitored using bone scans; a bone resorption marker, pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP); a bone formation marker, bone-specific alkaline phosphatase (BAI-p); and a tumor-specific marker (CA15-3). Bone scans were performed before and 3 or 4 months after therapy. After CAF therapy, markers were measured monthly. As a control, the markers of nine patients without bone metastases who received adjuvant CAF therapy were also measured monthly. The therapeutic effect on bone metastases was assessed after the study. Five patients had progression of disease (PD), three had no change (NC), and 15 patients had partial responses (PR). Bone scan flare-up was seen in five PR patients. In patients who received adjuvant therapy, ICTP, BAl-p, and CA15-3 did not change. ICTP increased significantly in PD patients. ICTP did not increase in either NC or PR, including bone scan flare patients. BAl-p and CA15-3 did not show any discernible pattern among PD, PR, flare, and NC patients. Thus measuring ICTP could distinguish PD from NC or PR patients' responses to CAF therapy. This was true also for patients who showed bone scan flare-up. Measuring a bone resorption marker, ICTP, allows clinicians to monitor patients' responses to CAF therapy and may prevent prolonged ineffective therapy or unnecessary changes in therapy as a result of the flare phenomenon.Keywords
This publication has 12 references indexed in Scilit:
- Dissociation of bone formation markers in bone metastasis of prostate cancerBritish Journal of Cancer, 1997
- Efficacy of Pamidronate in Reducing Skeletal Complications in Patients with Breast Cancer and Lytic Bone MetastasesThe New England Journal of Medicine, 1996
- Markers of type I collagen degradation and synthesis in the monitoring of treatment response in bone metastases from breast carcinomaBritish Journal of Cancer, 1996
- Bone metabolic markers in bone metastasesZeitschrift für Krebsforschung und Klinische Onkologie, 1995
- Healing flare in skeletal metastases from breast cancer.Radiology, 1994
- The flare phenomenon: far from fair and squareEuropean Journal of Nuclear Medicine and Molecular Imaging, 1994
- Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scanCancer, 1988
- The flare phenomenon on radionuclide bone scan in metastatic prostate cancerAmerican Journal of Roentgenology, 1984
- THE ASSESSMENT OF RESPONSE TO THERAPY OF BONE METASTASES IN BREAST CANCERAustralian and New Zealand Journal of Medicine, 1984
- Osseous metastases of breast cancer. Clinical, biochemical, radiographic, and scintigraphic evaluation of response to therapyCancer, 1984