Usefulness of Serum Carcinoembryonic Antigen (CEA) in evaluating response to chemotherapy in patients with advanced non small-cell lung cancer: a prospective cohort study

Abstract

BackgroundHigh serum carcinoembryonic antigen (CEA) levels are an independent prognostic factor for recurrence and survival in patients with non-small cell lung cancer (NSCLC). Its role as a predictive marker of treatment response has not been widely characterized.Methods180 patients with advanced NSCLC (stage IIIB or Stage IV), who had an elevated CEA serum level (>10 ng/ml) at baseline and who had no more than one previous chemotherapy regimen, were included. CEA levels were measured after two treatment cycles of platinum based chemotherapy (93%) or a tyrosine kinase inhibitor (7%). We assessed the change in serum CEA levels and the association with response measured by RECIST criteria.ResultsAfter two chemotherapy cycles, the patients who achieved an objective response (OR, 28.3%) had a reduction of CEA levels of 55.6% (95% CI 64.3-46.8) compared to its basal level, with an area under the ROC curve (AURC) of 0.945 (95% CI 0.91-0.99), and a sensitivity and specificity of 90.2 and 89.9%, respectively, for a CEA reduction of ≥14%. Patients that achieved a decrease in CEA levels ≥14% presented an overall response in 78% of cases, stable disease in 20.3% and progression in 1.7%, while patients that did not attain a reduction ≥14% had an overall response of 4.1%, stable disease of 63.6% and progression of 32.2% (p < 0.001). Patients with stable (49.4%) and progressive disease (22.2%) had an increase of CEA levels of 9.4% (95% CI 1.5-17.3) and 87.5% (95% CI 60.9-114) from baseline, respectively (p < 0.001). The AURC for progressive disease was 0.911 (95% CI 0.86-0.961), with sensitivity and specificity of 85 and 15%, respectively, for a CEA increase of ≥18%. PFS was longer in patients with a ≥14% reduction in CEA (8.7 vs. 5.1 months, p < 0.001). Reduction of CEA was not predictive of OS.ConclusionsA CEA level reduction is a sensitive and specific marker of OR, as well as a sensitive indicator for progression to chemotherapy in patients with advanced NSCLC who had an elevated CEA at baseline and had received no more than one chemotherapy regimen. A 14% decrease in CEA levels is associated with a longer PFS.

Prognostic Value of CYFRA 21-1 and Carcinoembryonic Antigen in Non-Small Cell Lung Cancer

“…Brechot et al [27] also reported CEA level of 27.1 ± 72.7 and 109 ± 404 ng/ml for respectable and unrespectable patients of NSCLC respectively. Several other reports documented lower [28] or higher [29] values of CEA than the present study in discussion.…”

“…In another study, Arrieta et al [29] documented amean baseline CEA of 242.8 ng/ml. The high value of CEA reported by Arrieta et al could be attributed to the fact that the majority of the studied NSCLC patients (84.4%) were in stage IV.…”

“…In addition, those with progressive disease detected by CT scans, had an increase of 31% of CYFRA 21-1 and 23% of CEA levels than their respective pre-treatment levels (Table 4). Arrieta et al [29] found reduction (≥ 14%) of serum CEA level than the baseline level after 2 cycles of treatment in advanced NSCLC cases. This was an accurate measurement of objective radiological response and correlates especially with adenocarcinoma histology.…”

Changing patterns of Serum CEA and CA199 for Evaluating the Response to First-line Chemotherapy in Patients with Advanced Gastric Adenocarcinoma

“…RECIST has good accuracy and objectivity and plays an important role in guiding clinical practice, and it is a common method in solid tumor clinical research (Bang et al, 2010). However, RECIST may be insufficient under certain circumstances, especially for patients who lack measurable lesions or who have lesions with edges that are difficult to confirm, such as malignant effusions, diffuse lymph node metastases, and bone metastases (Arrieta et al, 2013;Shimada et al, 2014). Erasmus et al (2003) used spiral CT to detect the size of 40 tumor lesions in 33 patients with lung cancer and found that the measurement results were often inconsistent with each other, which was likely to cause decreased accuracy in determining the treatment efficacy.…”

“…Serum tumor markers are detected automatically by machines and are often used for patient follow-up and prognosis determination. Recent studies have revealed that changes in the levels of serum markers have some value in predicting treatment efficacy for a variety of malignant tumors, especially ovarian cancer, colorectal cancer, and lung cancer (Hanke et al, 2001;Guppy and Rustin, 2007;Kim et al, 2010;Arrieta et al, 2013).…”