Serum tumor markers for response prediction and monitoring of advanced lung cancer: A review focusing on immunotherapy and targeted therapies

Abstract

BACKGROUND: The value of serum tumor markers (STMs) in the current therapeutic landscape of lung cancer is unclear. OBJECTIVE: This scoping review gathered evidence of the predictive, prognostic, and monitoring value of STMs for patients with advanced lung cancer receiving immunotherapy (IT) or targeted therapy (TT). METHODS: Literature searches were conducted (cut-off: May 2022) using PubMed and Cochrane CENTRAL databases. Medical professionals advised on the search strategies. RESULTS: Study heterogeneity limited the evidence and inferences from the 36 publications reviewed. While increased baseline levels of serum cytokeratin 19 fragment antigen (CYFRA21-1) and carcinoembryonic antigen (CEA) may predict IT response, results for TT were less clear. For monitoring IT-treated patients, STM panels (including CYFRA21-1, CEA, and neuron-specific enolase) may surpass the power of single analyses to predict non-response. CYFRA21-1 measurement could aid in monitoring TT-treated patients, but the value of CEA in this context requires further investigation. Overall, baseline and dynamic changes in individual or combined STM levels have potential utility to predict treatment outcome and for monitoring of patients with advanced lung cancer. CONCLUSIONS: In advanced lung cancer, STMs provide additional relevant clinical information by predicting treatment outcome, but further standardization and validation is warranted.

CYFRA 21-1, CA 125 and CEA provide additional prognostic value in NSCLC patients with stable disease at first CT scan

“…Several previous studies have supported the use of predictive and prognostic biomarkers to monitor response to various treatment modalities in NSCLC [25,26,[28][29][30]. A recent meta-analysis of studies analyzing the predictive and prognostic utility of CYFRA 21-1 and CEA concluded that both markers may be used for monitoring treatment response, and that biomarkers may have a role in prediction of treatment response [29,31], although no conclusions could be drawn based on patients' RECIST category. Despite the growing body of supporting evidence, the use of serum tumor markers for the monitoring of response to therapy has not yet been incorporated into current guidelines [5,14], possibly because it remains unclear how they should be used in conjunction with imaging.…”

Lung cancer biomarkers: Raising the clinical value of the classical and the new ones

“…Beyond classical chemotherapies they could become important diagnostic tools for modern therapies. This is shown in a review of van den Heuvel et al [39] on the role of serum tumor markers for response prediction and monitoring the response to immunotherapy and targeted therapies.…”