Chemotherapy-Induced Carcinoembryonic Antigen Surge in Patients with Metastatic Colorectal Cancer

Abstract

Objectives: To investigate the incidence of carcinoembryonic antigen (CEA) surge in patients with metastatic colorectal cancer (MCRC) and its implications on clinical outcome. Methods: A retrospective chart review of patients with MCRC treated with chemotherapy at Roswell Park Cancer Institute from January 2000 to May 2004 was conducted. A CEA surge was defined as an increase of >20% from baseline followed by a >20% drop in one or more subsequent CEA levels compared to baseline. The incidence of CEA surge and its association with clinical outcome was investigated. Results: Eighty-nine patients were evaluable for CEA surge. A CEA surge was documented in 10 patients. The CEA surge lasted <4 months in all 10 patients and was associated with a clinical benefit. No significant correlation was noted between CEA surge and site of primary tumor, site of metastatic disease, or tumor differentiation. Conclusions: CEA surges can be observed in patients receiving chemotherapy for MCRC and are often associated with a clinical benefit. None of the CEA surges satisfied the American Society of Clinical Oncology definition of CEA progression. A rise in CEA after initiation of chemotherapy, unless lasting >4 months, cannot be used as an indicator of progressive disease.

Follow up your unexpected clinical observations!

“…In fact our small, observational study led to a change in the ASCO recommendations for use of biomarkers in colorectal cancer [34]. Our findings were confirmed in a series of 89 patients where ten (11%) exhibited a CEA surge after initiation of chemotherapy [22]. However, a recent paper presented the use of serial recording of CEA after start of chemotherapy for colon cancer without taking into account the surge phenomenon which may affect 10Á15% of the patients, potentially leading to false conclusions [35,36].…”

Chemotherapy-induced transient CEA and CA19-9 surges in patients with metastatic or recurrent gastric cancer

“…Of 27 patients with metastatic CRC, four patients (15%) met the criteria of a CEA surge, and the time to reach the peak CEA level varied between 13 and 56 days. Ailawadhi et al [18]. also observed a CEA surge in ten (11%) of 89 CRC patients after 5-FU-based chemotherapy.…”

“…In breast cancer, serial CEA follow-up during chemotherapy showed initial rising and then declining CEA levels in 11 Á 48% of patients responding to chemotherapy [13Á16]. CEA surges are also commonly observed in patients with CRC [17,18]. Sørbye et al [17].…”

“…First, chemotherapeutic agents can induce an [18,27,28]. Second, tumor cell lysis may explain surge phenomena.…”

“…Two recent studies, which demonstrated a 'CEA surge' phenomenon in metastatic CRC, used the criterion of 'a !20% increase from the baseline CEA value followed by a !20% drop in subsequent CEA levels compared to the baseline value' [17,18]. We also used the same criterion for CEA surge in this study.…”