CA19-9 as a predictor of tumor response and survival in patients with advanced pancreatic cancer treated with gemcitabine based chemotherapy.
OBJECTIVE
The aim of this study was to determine the predictive role of pretreatment carbohydrate antigen 19-9 (CA19-9) measurement and its change after one cycle of gemcitabine-based therapy for response, time to progression (TTP) and overall survival (OS).


METHODS
Analyses were derived from three consecutive gemcitabine-containing phase II clinical trials between 1997 and 2004.


RESULTS
A total of 111 patients with pancreas cancer was studied. Baseline CA19-9 concentrations were dichotomized near the median. Lower baseline CA19-9 levels were positively associated with OS (median 9.1 vs 6.1 months, P = 0.0057) and TTP (median 6.4 vs 4.2 months, P = 0.0044).The covariate adjusted hazard ratio (HR) for progression among patients with baseline CA19-9 >or= 1000 ng/mL was HR = 1.94 (95% CI 1.24-3.02), with P = 0.0035. The covariate adjusted risk of death among patients with baseline CA19-9 >or= 1000 ng/ml was similarly elevated: HR = 1.90 (95% CI 1.23-2.94), with P = 0.0039. Change in CA19-9 levels from baseline to the end of treatment cycle 1 did not predict objective response (P = 0.75). There was somewhat longer OS (median 8.7 vs 7.1 months) and TTP (median 7.1 vs 5.4 months) in patients with >or=50% reduction in serum CA19-9 concentrations, but this was not statistically significant (P = 0.74 and 0.81, respectively).


CONCLUSIONS
Baseline CA19-9 levels may predict survival in patients with advanced pancreas cancer. The change in CA19-9 levels determined within 1 month of the initiation of therapy did not predict treatment outcome.
Hammad
Nazik
N
Division of Hematology and Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
Heilbrun
Lance K
LK
Philip
Philip A
PA
Shields
Anthony F
AF
Zalupski
Mark M
MM
Venkatramanamoorthy
Raghu
R
El-Rayes
Bassel F
BF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018395:CA-19-9 Antigen / Q000097:blood*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D000093542:Gemcitabine
D018395:CA-19-9 Antigen; D003841:Deoxycytidine; D000093542:Gemcitabine