Decrease of CA 19–9 during chemotherapy with gemcitabine predicts survival time in patients with advanced pancreatic cancer

Abstract

Chemotherapy with gemcitabine has been shown to be an effective regimen in advanced or metastatic pancreatic cancer with improvement of both quality of life and survival time. The response of the tumour marker CA 19–9 to chemotherapy with gemcitabine was studied in order to find out whether it is related to survival time of patients. Forty-three consecutive patients (median age 61 years, range 39–76 years; 20 males, 23 females) suffering from histologically proven locally advanced or metastatic pancreatic adenocarcinoma and a baseline Karnofsky-index ≥ 60 were treated with gemcitabine in a dose of 1000 mg m−2weekly × 7 followed by 1 week of rest during the first cycle and thereafter 1000 mg m−2weekly × 3 followed by 1 week of rest until progression. In 36 of 43 patients serial measurements of CA 19–9 could be performed. Patients with a decrease of > 20% of the baseline CA 19–9 level after 8 weeks of treatment (n = 25) had a significantly better median survival than patients with a rise or a decrease ≤ 20% (n = 11) (268 vs 110 days;P< 0.001). The response of CA 19–9 was the strongest independent predictor of survival (P< 0.001) in the multivariate analysis. In conclusion, a decrease of CA 19–9 > 20% during the first weeks of chemotherapy with gemcitabine is associated with a better survival of patients with locally advanced or metastatic pancreatic cancer. Serial measurements of CA 19–9 are useful to decide whether further chemotherapy after the first weeks of treatment is indicated. © 2000 Cancer Research Campaign

Serum CA19-9 response as a surrogate for clinical outcome in patients receiving fixed-dose rate gemcitabine for advanced pancreatic cancer

“…A small retrospective study by Saad et al (2002) of 28 patients with advanced pancreatic cancer treated with gemcitabine found that lower pretreatment levels of CA19-9, as well as a X50% decline in CA19-9 anytime during treatment, correlated with better survival rates. Halm et al (2000) examined 43 unresectable patients receiving gemcitabine treatment and found that those with a 420% decrease of their baseline CA19-9 level after 8 weeks of treatment had a longer median survival than those with a rise or a decrease o20% (268 vs 110 days), a finding confirmed by Ziske et al (2003). This biomarker response was in fact the only independent predictor of survival in a multivariate analysis, showing a greater level of significance than either objective tumour response or clinical benefit response (Ziske et al, 2003).…”

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].…”

“…Halm et al evaluated CA 19-9 serum levels in 36 patients enrolled in gemcitabine chemotherapy trials and reported that patients with a decline in CA 19-9 serum levels of >20% from baseline after 8 weeks of treatment (N=25) had improved median survival compared to patients with a rise or a decrease of <20% (N=11) (268 vs. 110 days, p<0.001) [55]. Moreover, treatment related decline in CA 19-9 serum levels was the strongest independent predictor of survival (p<0.001) on multivariate analysis.…”

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“…Gem, for the last couple of decades in a lot of clinical trials [19][20][21][22][23] has been considered the reference standard treatment in advanced pancreatic cancer as a first line treatment or a Gem based combination regimen in improving QoL of patients, but all of them have provided disappointing results in the way of survival possibility.…”