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4.02.2013

Marc Lippman, M.D., Publishes New England Journal of Medicine Editorial on Breast Cancer Study

A new approach for monitoring metastatic breast cancer has “remarkable potential,” according to Marc Lippman, M.D., the Kathleen and Stanley Glaser Professor of Medicine and Deputy Director of the University of Miami Sylvester Comprehensive Cancer Center.

In an editorial titled “Circulating Tumor DNA – Ready for Prime Time?” and published March 28 in the New England Journal of Medicine, Lippman and co-author Kent Osborne, M.D., of Baylor College of Medicine in Houston, note the significance of a United Kingdom breast cancer study reported in the same issue.

“Multiple aspects of the management of metastatic breast cancer need improvement,” Lippman says in the column. “Patients are anxious about their risk of recurrence and disappointed at the lack of reliable tests for early detection of recurrence.”

The UK study, “Analysis of Circulating Tumor DNA to Monitor Metastatic Breast Cancer,” by Sarah-Jane Dawson, F.R.A.C.P., Ph.D., Department of Oncology, University of Cambridge, and 17 co-authors, looked at cancer tumor cells circulating in 30 women with metastatic breast cancer who were receiving systemic therapy. The researchers used genetic sequencing to identify DNA alterations and were successful in detecting mutations in 29 of the 30 women.

In the editorial, Lippman said the study demonstrated that when mutations could be detected in a patient’s primary tumor and in the blood plasma, the number of copies of circulating tumor DNA was reasonably correlated with the patient’s responses to treatment. In other words, there was a significant relationship between the number of DNA copies in blood and the ultimate prognosis of the patient.

However, Lippman noted that while mutations could be detected in nearly all study participants, the specific structural variations could only be tracked in about 60 percent of the women. Therefore, it may be difficult and costly to develop specific tests for individual patients.

“Despite these concerns, there is remarkable potential for this approach,” Lippman said in the editorial. Tests of circulating tumor DNA might be able to identify patients who would not need further therapy, or those with localized breast cancer who would be adequately treated by lumpectomy, a partial breast removal. Circulating tumor DNA tests might also be used to screen for recurrences in patients with previously diagnosed early-stage disease, although this potential use has not been proven to improve patient outcomes.

“The new study provides proof of the concept that circulating tumor DNA represents a sensitive biomarker of tumor burden,” said Lippman, adding that “further studies are clearly warranted.”

Board-certified in hematology/oncology, internal medicine, and endocrinology, diabetes and metabolism, Lippman is widely known for his research in breast cancer. In his illustrious career, he has received numerous awards, including the Mallinckrodt Award of the Clinical Radioassay Society in 1978; the Commendation Medal, USPHS in 1982; Meritorius Service Medal, USPHS in 1987; Clinical Investigator Award, American Federation for Clinical Research in 1985; D.R. Edwards Lecture and Medal, Tenovus Institute, Wales 1985; Plenary Lecturer, British Association of Cancer Research in 1987; and the Gosse Lecture, Dalhuosie University, Halifax Nova Scotia in 1987.

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