The use of tumour markers CEA, CA-195 and CA-242 in evaluating the response to chemotherapy in patients with advanced colorectal cancer

Abstract

Summary Tumour markers CEA, were measured in 33 patients undergoing chemotherapy for advanced colorectal cancer. The aim was to determine whether they could be used to accurately monitor the course of the disease, and reduce the need for imaging. Treatment with a 5-fluorouracil based regimen resulted in a partial response in nine patients (27%), whereas the remainder either had disease stabilisation or suffered from progression. Before treatment the CEA was elevated in 85% of patients and the and CA-242 in 78%. All three markers were elevated in 70% and at least one elevated in 93%. (Hammarstrom, 1985;Gupta et al., 1987;Safi et al., 1987;Sagar et al., 1991;Nilsson et al., 1992). Although none of these markers has proved to be of any particular value in screening for the disease, CEA is commonly used to assess the progress of patients following surgical treatment (Minton et al., 1985) and remains the 'gold standard'. Other markers appear less useful in isolation, but when combined as a panel with CEA may be of greater value than any one marker on its own (Safi et al., 1987;Persson et al., 1989). The aim of this study was to assess whether three tumour markers CEA, are of value in monitoring the progress of patients being treated with systemic chemotherapy for advanced colorectal cancer. Patients and methods PatientsThirty-three patients were studied; 24 were male and nine female, mean ages 58 (range 27-76) and 60 (42-78) respectively. All patients had histologically proven colorectal cancer with metastases. Twenty-six had liver metastases, ten locoregional disease, eight lung metastases, and two with disease at other sites. Several of these patients had disease at more than one site. The patients were a consecutive series in chemotherapy studies which required that the disease was measurable on CT scan. The time interval between presentation with the primary tumour and recurrent disease averaged at 16 months with a range of 0-91 months. Performance status was assessed by means of the Karnofsky scale (Karnofsky et al., 1948), the average being 80 with a range of 70-90.The study was approved by Leeds Eastern District Clinical Research (Ethics) Committee.Treatment schedule All patients received chemotherapy with a 5-fluorouracil (5-FU) based regimen as detailed below. Some of these patients were being treated in a multi-centre study comparing 5-FU and interferon alpha with 5-FU and leucovorin. The results of this study will be published separately. In the 5-FU/ interferon based regimen 5-FU was administered as a continuous intravenous infusion over a period of 5 days at a daily dose of 750 mg m2 followed by weekly intravenous bolus doses also of 750 mg m-2 commencing on day fifteen. Interferon alpha-2a 9 MU, was administered as a subcutaneous injection three times weekly. In the 5-FU/ leucovorin based regimen I-leucovorin 200 mg m-2 was infused over 10 min and followed within 5 min by a bolus of 5-FU at 370 mg m-2 for 5 consecutive days. This cycle was repeated every 4 weeks. Tumour markersA 10 ml sample of ...

Inhibition of tumour growth by marimastat in a human xenograft model of gastric cancer: relationship with levels of circulating CEA

“…Tumour antigen levels have been used for many years in the clinical management of cancer (Goldenberg et al, 1981). They have proved of value in detecting recurrent disease (NIH Consensus Statement, 1981;Hida et al, 1996), monitoring the effects of chemotherapy and predicting prolonged survival (Hine and Dykes, 1984;AllenMersh et al, 1987;Ward et al, 1993). A combined analysis of marimastat clinical trials, in patients with carcinoma of the pancreas, ovary, colon and prostate, has demonstrated a dose-dependent reduction in the rate of rise of cancer antigens (Nemunaitis et al, 1998).…”

Tissue polypeptide-specific antigen (TPS) in monitoring palliative treatment response of patients with gastrointestinal tumours

“…Evaluation by this means is, however, expensive and time-consuming for the patient. A simple and inexpensive method to monitor response would be the repeated measurement of tumour markers such as carcinoembyronic antigen (CEA), CA 19-9 or , which are commonly elevated in patients with gastrointestinal cancer (Martin et al, 1976;Safi et al, 1978;Kornek et al, 1992;Ward et al, 1993). It is recognised, however, that these markers do not always accurately reflect the course of the disease.…”

“…It is recognised, however, that these markers do not always accurately reflect the course of the disease. The limitations to their use in isolation is the overestimation of the number of patients who respond to treatment and, more seriously, underestimation of the number suffering progressive disease as demonstrated on CT (Allen-Mersh et al, 1986;Ward et al, 1993).…”

The role of CA-242 and CEA in surveillance following curative resection for colorectal cancer

“…The recent studies of showed that it has a higher sensitivity than CA-50 in primary colorectal cancer and a low false positivity in benign liver disease (Kuusela et al, 1991;Nilsson et al, 1992). In prinary colorectal cancer, additional use of CA-242 improves the diagnostic sensitivity of CEA alone (though it still remains limited) (Roberts et al, 1992), and CA-242 has also been shown to compklment CEA monitoring of patients reiing chemotherapy for liver metasta from colorectal cancer (Ward et al, 1993 …”