Use of ceruloplasmin levels to monitor response to therapy and predict recurrence of breast cancer.

Ceruloplasmin (CP), an acute phase reactant, has been found to be elevated in patients with various tumors including breast cancer. We found that the CP level was elevated in 89% of 103 patients with metastatic breast cancer. In 27 patients with measurable metastatic disease that responded to treatment the mean CP level fell by 35% (p less than 0.001) and in 22 patients whose disease progressed on treatment, the mean CP level rose by 44% (p less than 0.001). Of those patients with Stage II breast cancer that were treated with adjuvant chemotherapy, only 6% of patients with a normal post mastectomy CP level have recurred, whereas 44% of patients with an elevated post mastectomy CP level have recurred (p less than 0.01). In following patients with breast cancer, we noted that in those patients that recurred, the CP level became elevated 16-34 weeks prior to any clinical evidence of metastases. We also noted that the CP level became elevated after initially falling in patients receiving adjuvant chemotherapy and on occasion, the initially elevated CP level did not even fall. These circumstances may represent resistant microscopic disease, so that changing to a noncross-resistant chemotherapeutic regimen might be appropriate.