H. J. Stemmler, P. Stieber, V. Heinemann
Can CA19-9 kinetics replace imaging procedures in response evaluation
of patients undergoing chemotherapy for metastatic pancreatic cancer? / Kann die Kinetik des CA19-9 bei der Response-Evaluation von chemotherapeutisch behandelten
Patienten mit metastas
Background: Response evaluation by standard imaging
procedures such as computed tomography (CT) may be
difficult in patients undergoing chemotherapy for
advanced and metastatic pancreatic cancer. The aim of
the study was to determine whether kinetics of CA19-9
levels can replace imaging procedures in evaluating the
response to chemotherapy in these patients.
Patients and methods: Patients with advanced or
metastatic pancreatic cancer were included in the study.
Patients received a combination chemotherapy consisting
of gemcitabine (1000 mg m?2 d1, 8, 15) and cisplatin
(50 mg m?2 d1, 15) repeated on day 29. Treatment was
continued until unacceptable toxicity or disease progression
occurred. CA19-9 levels were measured directly
before each cytotoxic treatment cycle. CA19-9 response
was defined by a ?50% decrease in CA19-9 serum levels
within two months after treatment initiation.
Results: A total of 77 patients with initially elevated
CA19-9 levels were included for evaluation (f/m = 26/61;
stage 3/4 = 24/63). Out of 15 patients who had responded
to chemotherapy regarding imaging criteria (CR 4, PR
11, OR 19.5%), 14 patients were classified as CA19-9
responders. Although 62 patients had not responded to
chemotherapy by CT-imaging criteria, 29 patients fulfilled
the criterion of a CA19-9 responder. The low value of
CA19-9 kinetics in predicting imaging results (positive
predictive value 32.5%) seems to be clinically irrelevant
since CA19-9 responders, independent of imaging criteria,
have a significant improvement of survival time
compared to non-responders (295 days; 95%CI:
285–445 vs 174 days; 95%CI: 134–198; p = 0.022).
Conclusion: CA19-9 kinetics are unable to predict
tumor response regarding imaging criteria. However, the
kinetic of CA19-9 in a patient undergoing chemotherapy
for pancreatic cancer seems to be a reliable indicator in
predicting survival.
LaboratoriumsMedizin, Walter de Gruyter
Print ISSN: 0025-8466
Volume: 28, 04/2004
Pages: 103 - 108
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