D-dimer as a predictive biomarker of response to chemotherapy in patients with metastatic breast cancer.

Abstract

e13000 Background: Tumor-induced coagulation is considerably observed in cancer patients. Moreover, it is associated with tumorigenesis, tumor progression, and metastasis, by creating a proliferative and proangiogenic microenvironment. Therefore, D-dimer, a fibrin degradation product, correlates with tumor prognosis in several cancer types. This study aims to investigate whether D-dimer levels can be a predictive and monitoring indicator for chemotherapy response in metastatic breast cancer (MBC) patients. Methods: This study included two groups, 76 patients diagnosed with metastatic breast carcinoma, and 25 with early breast carcinoma as a control group. Plasma D-dimer levels were measured prospectively before chemotherapy initiation, and after the fourth treatment cycle in MBC patients. The levels of D-dimer before chemotherapy (D0) were analyzed using receiver operating characteristic (ROC) curves to determine the optimal cutoff baseline values of D0, and to evaluate their discriminatory abilities in predicting response to chemotherapy. Results: In the preliminary response evaluation, the mean level of D-dimer significantly decreased by 2.74 μg/ml in patients with partial response, and by 2.17 μg/ml in patients with stable disease. In the progression disease group, a considerable increase was seen in D-dimer levels by 2.16 μg/ml. Analysis of ROC curves showed that D-dimer levels at D0 could discriminate the response to chemotherapy, whereas the progressive disease rate correlated with higher levels of D-dimer (>1.055 μg/ml; P= 0.000). Conclusions: D-dimer level in plasma is a useful predictive and monitoring marker of response to chemotherapy in metastatic breast cancer.