The level of serum carcinoembryonic antigen is a surrogate marker for the efficacy of EGFR-TKIs but is not an indication of acquired resistance to EGFR-TKIs in NSCLC patients with EGFR mutationsm

Han, Jing-Quan; Li, Yuzhang; Cao, Shouqiang; Dong, Qing; Zhao, Guibin; Zhang, Xiangyu; Cui, Jian

doi:10.3892/br.2017.914

Cited by 5 publications

(6 citation statements)

References 38 publications

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“…The expected survival benefit of EGFR-TKI treatment was higher in MPE patients with elevated PF-CEA levels. This observation is consistent with those in previous studies that demonstrated the greater efficacy of EGFR-TKI treatment in patients with elevated S-CEA levels [ 19 , 20 ]. One hypothesis states that a possible antiapoptotic signal of the mutant EGFR pathway may enhance CEA protein expression in tumors [ 21 ].…”

Section: Discussionsupporting

confidence: 93%

Clinical impact of pleural fluid carcinoembryonic antigen on therapeutic strategy and efficacy in lung adenocarcinoma patients with malignant pleural effusion

Lee,

Park

et al. 2024

Korean J Intern Med

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Background/Aims: Epidermal growth factor receptor (EGFR) mutation is important in determining the treatment strategy for advanced lung cancer patients with malignant pleural effusion (MPE). Contrary to serum carcinoembryonic antigen (S-CEA) levels, the associations between pleural fluid CEA (PF-CEA) levels and EGFR mutation status as well as between PF-CEA levels and treatment efficacy have rarely been investigated in lung adenocarcinoma patients with MPE.Methods: This retrospective study enrolled lung adenocarcinoma patients with MPE and available PF-CEA levels and EGFR mutation results. The patients were categorized based on PF-CEA levels: < 10 ng/mL, 10–100 ng/mL, 100–500 ng/mL, and ≥ 500 ng/mL. The association between PF-CEA levels and EGFR mutation status as well as their therapeutic impact on overall survival was compared among the four groups.Results: This study included 188 patients. PF-CEA level was found to be an independent predictor of EGFR mutation but not S-CEA level. The EGFR mutation rates were higher as the PF-CEA levels increased, regardless of cytology results or sample types. Among EGFR-mutant lung adenocarcinoma patients receiving EGFR-tyrosine kinase inhibitor (TKI) treatment, those with high PF-CEA levels had significantly better survival outcomes than those with low PF-CEA levels.Conclusion: High PF-CEA levels were associated with high EGFR mutation rate and may lead to a favorable clinical outcome of EGFR-TKI treatment in EGFR-mutant lung adenocarcinoma patients with MPE. These findings highlight the importance of actively investigating EGFR mutation detection in patients with suspected MPE and elevated PF-CEA levels despite negative cytology results.

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Section: Discussionsupporting

confidence: 93%

Clinical impact of pleural fluid carcinoembryonic antigen on therapeutic strategy and efficacy in lung adenocarcinoma patients with malignant pleural effusion

Lee,

Park

et al. 2024

Korean J Intern Med

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“…Several studies have reported the relationship between tumour markers and the effect of NSCLC therapy, including EGFR-TKIs. CEA level has been demonstrated to be associated with the prognosis of patients on EGFR-TKIs and other treatments for NSCLC 7,25,26. In our study, a higher CEA level was associated with a poor outcome of EGFR-TKI (9.6 mo.…”

Section: Discussionsupporting

confidence: 53%

<p>The Prediction Of Epidermal Growth Factor Receptor Mutation And Prognosis Of EGFR Tyrosine Kinase Inhibitor By Serum Ferritin In Advanced NSCLC</p>

Wu¹,

Dai²,

Chen³

2019

CMAR

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PurposeTo investigate the association between level of serum ferritin (SF) and epidermal growth factor receptor (EGFR) mutations and to analyse the impact of SF level on survival times in advanced non-small-cell lung cancer (NSCLC) patients taking EGFR tyrosine kinase inhibitors (EGFR-TKIs).MethodsA total of 301 patients who were admitted to the Chinese PLA general hospital from August 2015 to August 2017 were enrolled. The association between tumour markers, including SF, CEA, and EGFR mutation, and their impact on the prognosis of patients taking EGFR-TKIs was investigated.ResultsIn all patients, the percentage of patients with EGFR mutations was 52.5% (158/301). EGFR mutations were more likely to be detected in younger (<60 years old), adenocarcinoma patients, non-smokers, women, CEA≥5 µg/L and serum ferritin ≥129 µg/L for females or ≥329 µg/L for males (p<0.05). Increased serum ferritin was an independent factor for predicting EGFR mutations (odds ratio (OR)=4.593, 95% CI (2.673–7.890); P <0.001), and an area under curve (AUC) of 0.711 was shown to predict EGFR mutations with a sensitivity of 81.7% and a specificity of 65.2% in women. Sensitivity increased to 91.1% when combining SF and CEA in all patients. SF was also an independent factor (HR=3.531, 95% CI (2.288–5.448); P<0.001) for predicting progression-free survival (PFS) of patients on EGFR-TKIs, analysed by a Cox proportional hazard model, as PFS was shorter in patients with higher SF (15.0 mo. (SF < 129 µg/L for females or <329 for males) vs 10.0 mo. (129–258 µg/L for females or 329–658 µg/L for males) vs 7.3 mo. (>258 µg/L (>258 µg/L for females or >658 µg/L for males) p<0.001).ConclusionSF was a significant predictor of EGFR mutation with moderate diagnostic accuracy, and combining SF and CEA increased the diagnostic sensitivity and specificity for EGFR mutations. SF was also useful for predicting survival in EGFR-TKIs.

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“…Especially CYFRA 21-1 demonstrated high prognostic relevance across various therapeutic settings, stages and histologic subgroups. While elevated STM levels were often associated with poor prognosis, the relationship with CEA in TKI therapies was more controversial, as high CEA levels also predicted longer OS [113] and PFS in several studies [99][100][101][102][103][104]. A growing number of studies considered the inclusion of established clinical prognostic markers such as performance score, TNM stage, and histology, which were also the most important clinical parameters with prognostic relevance.…”

Section: Discussionmentioning

confidence: 99%

“…Remarkably, it was found that low CEA levels had a negative predictive value for PFS in patients treated with TKIs [99][100][101][102][103][104], but also in those undergoing chemotherapy and/or radiotherapy [33] and immunotherapy [43], reflecting the low comparability of individual studies with different conclusions drawn. A randomized phase II trial [99], investigating 138 advanced NSCLC patients treated either with combinations of the VEGFR/PDGFR inhibitor linifanib and chemotherapy or chemotherapy alone reported longer PFS in patients with high CEA >3 ng/mL and low CYFRA 21-1 <7 ng/mL signature in the TKI arm.…”

Section: Other Serum Tumor Markers and Combinationsmentioning

confidence: 99%

Prognostic value of blood-based protein biomarkers in non-small cell lung cancer: A critical review and 2008–2022 update

Trulson,

Holdenrieder

2024

TUB

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BACKGROUND: Therapeutic possibilities for non-small cell lung cancer (NSCLC) have considerably increased during recent decades. OBJECTIVE: To summarize the prognostic relevance of serum tumor markers (STM) for early and late-stage NSCLC patients treated with classical chemotherapies, novel targeted and immune therapies. METHODS: A PubMed database search was conducted for prognostic studies on carcinoembryonic antigen (CEA), cytokeratin-19 fragment (CYFRA 21-1), neuron-specific enolase, squamous-cell carcinoma antigen, progastrin-releasing-peptide, CA125, CA 19-9 and CA 15-3 STMs in NSCLC patients published from 2008 until June 2022. RESULTS: Out of 1069 studies, 141 were identified as meeting the inclusion criteria. A considerable heterogeneity regarding design, patient number, analytical and statistical methods was observed. High pretherapeutic CYFRA 21-1 levels and insufficient decreases indicated unfavorable prognosis in many studies on NSCLC patients treated with chemo-, targeted and immunotherapies or their combinations in early and advanced stages. Similar results were seen for CEA in chemotherapy, however, high pretherapeutic levels were sometimes favorable in targeted therapies. CA125 is a promising prognostic marker in patients treated with immunotherapies. Combinations of STMs further increased the prognostic value over single markers. CONCLUSION: Protein STMs, especially CYFRA 21-1, have prognostic potential in early and advanced stage NSCLC. For future STM investigations, better adherence to comparable study designs, analytical methods, outcome measures and statistical evaluation standards is recommended.

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The level of serum carcinoembryonic antigen is a surrogate marker for the efficacy of EGFR-TKIs but is not an indication of acquired resistance to EGFR-TKIs in NSCLC patients with EGFR mutationsm

Cited by 5 publications

References 38 publications

Clinical impact of pleural fluid carcinoembryonic antigen on therapeutic strategy and efficacy in lung adenocarcinoma patients with malignant pleural effusion

Clinical impact of pleural fluid carcinoembryonic antigen on therapeutic strategy and efficacy in lung adenocarcinoma patients with malignant pleural effusion

<p>The Prediction Of Epidermal Growth Factor Receptor Mutation And Prognosis Of EGFR Tyrosine Kinase Inhibitor By Serum Ferritin In Advanced NSCLC</p>

Prognostic value of blood-based protein biomarkers in non-small cell lung cancer: A critical review and 2008–2022 update

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