Table 1 Expert panels that include uPA and PAI-1 measurements in their guidelines

ASCO

uPA/PAI-1 measured by ELISAs may be used for the determination of prognosis in patients with newly diagnosed, node-negative breast cancer. Low levels of both markers are associated with a sufficiently low risk of disease recurrence, especially in steroid hormone receptor-positive women who will receive adjuvant endocrine therapy and who will receive only minimal additional benefit from chemotherapy. Furthermore, CMF-based adjuvant chemotherapy, compared with observation alone, provides substantial benefit in patients with a high risk of disease recurrence as determined by high levels of uPA and PAI-1.

NACB

Testing for uPA and PAI-1 may be carried out to identify lymph node-negative patients who do not need or are unlikely to benefit from adjuvant chemotherapy. Measurement of both proteins should be performed because the information provided by the combination is superior to that from either alone. Lymph node-negative patients with low levels of both uPA and PAI-1 have a low risk of disease recurrence and thus may be spared from the toxic side effects and costs of adjuvant chemotherapy. Lymph node-negative women with high levels of either uPA or PAI-1 should be treated with adjuvant chemotherapy.

EGTM

Recommends uPA and PAI-1 for determining prognosis in breast cancer, especially in the group of patients with lymph node-negative disease. Validated ELISAs (that is, validated for both analytical and clinical performance) should be used for determining these proteins.

ESMO

uPA-PAI-1, a marker of tumor invasiveness, has been validated in prospective clinical trials as a prognostic marker for both node-negative and node-positive breast cancer and can be used in treatment decision making for early breast cancer.

AGO

Recommends uPA and PAI-1 for determining prognosis in breast cancer, especially in the group of patients with lymph node-negative disease. It also acknowledges the predictive impact of the test.