Are serial measurements of CA19-9 useful in predicting response to chemotherapy in patients with inoperable adenocarcinoma of the pancreas?

Abstract

Summary Thirty-nine patients with inoperable adenocarcinoma of the pancreas were studied (27 male, 12 female; median age 60 years, range 39-75 years). All patients received chemotherapy with continuous infusion 5-fluorouracil with intravenous bolus epirubicin followed by cisplatin, repeated every 21 days for a total of six cycles and were evaluable for response. Serum CAl 9-9 concentrations were obtained at baseline and before each cycle. A rise or fall in the tumour marker was defined as a greater than 15% increase or decrease in the marker on two consecutive occasions 3 weeks apart. A plateau in the tumour marker was defined as a less than 15% decrease or increase on two occasions. Changes in marker expression were compared with serial computerized tomography scanning before treatment and after the third and sixth cycle of chemotherapy. Thirty-five of 39 patients had an elevated CA19-9 (87.9%). Thirteen (36.2%) exhibited a decrease, seven (19.4%) a plateau and 16 (44.4%) patients had a progressive rise in serum CAl 9-9. The sensitivity of CAl 9-9 was 67% for predicting a partial response and 86% for progressive disease. The median survival for the 13 patients exhibiting a reduction was 333 days, for the seven patients exhibiting a plateau 253 days and for those who had a progressive rise 185 days. The difference in median survival between the group of patients with > 15% decrease and those with > 15% increase of CAl 9-9 was significant (P = 0.001). In the cohort of patients who exhibited a reduction in CAl 9-9, no tumour progression was seen, and the reduction occurred during the first three cycles of treatment. Thus, interval scanning may be avoided in this group of patients.

CA19-9 as a prognostic factor in inoperable pancreatic cancer: the implication for clinical trials

“…Previous studies have demonstrated a prognostic role for pretreatment CA19-9 in patients receiving radiotherapy or undergoing pancreatic resection (Glenn et al, 1988). Although a small number of papers have described a fall in CA19-9 to be an independent prognostic variable for survival (Gogas et al, 1998;Saad et al, 2002;Stemmler et al, 2003;Ziske et al, 2003), there have been surprisingly few studies investigating the use of baseline CA19-9 in predicting survival for patients with inoperable pancreatic cancer who undergo systemic chemotherapy. Halm et al (2000) reported the survival of 43 consecutive patients with advanced pancreatic cancer treated with single-agent gemcitabine.…”

“…Despite a small number of publications suggesting that the tumour marker CA19-9 is an important prognostic variable (Gogas et al, 1998;Halm et al, 2000;Saad et al, 2002;Stemmler et al, 2003;Ziske et al, 2003), none of the large published randomised studies of chemotherapy to date have reported baseline CA19-9 levels.…”

Serum CA 19-9 as a Biomarker for Pancreatic Cancer—A Comprehensive Review

“…Whether serum CA 19-9 levels can be used as a surrogate marker of response to chemotherapy has been studied in a variety of clinical settings [41,44,[53][54][55][56][57][58][59][60][61][62][63][64]. Willett et al measured CA 19-9 serum levels in 42 resectable pancreatic cancer patients receiving neoadjuvant treatment with 5-flourouracil and external beam radiation prior to planned pancreaticoduodenectomy.…”

“…Nearly all studies have demonstrated that a treatment related decline in CA 19-9 serum levels is associated with prolonged survival and is an independent predictor of overall survival [41,44,[53][54][55][56][57][58][59][60][61][62][63][64] (Table 5). Reni et al compared basal CA 19-9 serum levels in 247 advanced pancreatic cancer patients enrolled in five consecutive chemotherapy trials (G, gemcitabine; PEFG, cisplatin, epirubicin, 5-fluorouracil, and gemcitabine; PDXG, cisplatin, docetaxel, capecitabine, and gemcitabine) [60].…”

Alternative antibody for the detection of CA19-9 antigen: a European multicenter study for the evaluation of the analytical and clinical performance of the Access® GI Monitor assay on the UniCel® DxI 800 Immunoassay System

“…Several studies have reported a close correlation between CA19-9 kinetics and therapy response, even if they used different definitions of CA19-9 decrease as criterion for therapy efficacy (6,(26)(27)(28)(29)(30)(31). Stemmler et al demonstrated CA19-9 decreases during chemotherapyindependent from their degree -were associated with longer survival, whereas increasing levels were linked with poor prognosis (31).…”