CA 19-9 response as an early indicator of the effectiveness of gemcitabine in patients with advanced pancreatic cancer.
BACKGROUND
The CA 19-9 decline 8 weeks after gemcitabine administration has been shown to be a useful prognosticator of survival in patients with pancreatic cancer. We assessed the prognostic value of changes in CA 19-9 levels 4 weeks after treatment initiation on overall survival (OS) and time to progression (TTP).


METHODS
We evaluated 72 patients who received gemcitabine for advanced pancreatic cancer. The serum CA 19-9 level was measured routinely at baseline (CA 19-9_Pre) and after the first (4 weeks; CA 19-9_A1) and second (8 weeks; CA 19-9_A2) courses. CA 19-9 responses were categorized into quartiles using the proportional change in CA 19-9.


RESULTS
The rates of decrease in CA 19-9_A1 and CA 19-9_A2 were strongly correlated with each other (r = 0.8981, p < 0.0001). Multivariate analysis revealed that an early CA 19-9 response was prognostic of OS and TTP in addition to CA 19-9_Pre and performance status. Compared with the first quartile of an early CA 19-9 response, hazard ratios for the second, third and fourth quartiles were 0.91 (95% confidence interval, CI, 0.59-1.34), 0.71 (95% CI, 0.45-1.08), and 0.63 (95% CI, 0.41-0.94) for TTP, respectively (p for trend = 0.002), and 0.98 (95% CI, 0.61-1.49), 0.68 (95% CI, 0.40-1.08) and 0.79 (95% CI, 0.50-1.21) for OS (p for trend = 0.036).


CONCLUSIONS
CA 19-9 response after the first course of gemcitabine was a prognosticator of OS and TTP in patients with advanced pancreatic cancer.
Nakai
Yousuke
Y
Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Kawabe
Takao
T
Isayama
Hiroyuki
H
Sasaki
Takashi
T
Yagioka
Hiroshi
H
Yashima
Yoko
Y
Kogure
Hirofumi
H
Arizumi
Toshihiko
T
Togawa
Osamu
O
Ito
Yukiko
Y
Matsubara
Saburo
S
Hirano
Kenji
K
Sasahira
Naoki
N
Tsujino
Takeshi
T
Tada
Minoru
M
Omata
Masao
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D003841:Deoxycytidine; D000093542:Gemcitabine