title: CA19-9 as a predictor of tumor response and survival in patients with advanced pancreatic cancer treated with gemcitabine based chemotherapy.
abstract: 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.
authors.affiliation: Division of Hematology and Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
authors.forename: Nazik
authors.initials: N
authors.lastname: Hammad
authors.forename: Lance K
authors.initials: LK
authors.lastname: Heilbrun
authors.forename: Philip A
authors.initials: PA
authors.lastname: Philip
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Shields
authors.forename: Mark M
authors.initials: MM
authors.lastname: Zalupski
authors.forename: Raghu
authors.initials: R
authors.lastname: Venkatramanamoorthy
authors.forename: Bassel F
authors.initials: BF
authors.lastname: El-Rayes
mesh_terms: 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
chemical_list: D018395:CA-19-9 Antigen; D003841:Deoxycytidine; D000093542:Gemcitabine