title: Prognostic Value of Serum Tumor Markers in Medullary Thyroid Cancer Patients Undergoing Vandetanib Treatment.
abstract: Tyrosine kinase inhibitors (TKIs) such as vandetanib have shown clinical effectiveness in advanced medullary thyroid cancer (MTC). During TKI treatment, fluctuations in the tumor markers carcinoembryonic antigen (CEA) and calcitonin (CTN) are frequently observed. Their role for treatment monitoring and the decision-making process has not been fully elucidated yet.Twenty-one patients (male, 16, female, 5; mean age, 49 ± 13 years) with progressive MTC receiving vandetanib (300 mg orally per day) were considered. Tumor restaging was performed every 3 months including contrast-enhanced computed tomography (CT). Response was assessed according to recent criteria (Response Evaluation Criteria in Solid Tumors, RECIST 1.1). Additionally, CEA and CTN were measured at the day of CT imaging and alterations observed in tumor markers were compared to respective imaging findings (partial response, PR; stable disease, SD; progressive disease, PD).During long-term follow-up (510 ± 350 days [range, 97-1140 days]), CTN and CEA levels initially dropped in 71.4% and 61.9% of the patients followed by fluctuations in serum marker levels. A rise in CTN ≥39.5% between 2 subsequent measurements (defined by ROC analysis) had a sensitivity of 70.6% and a specificity of 83.2% in predicting PD with an accuracy of 82.0% (area under the curve (AUC), 0.76). Oscillations in CEA levels were not predictive for PD.Whereas tumor marker fluctuations in MTC patients undergoing TKI treatment are a frequent phenomenon, a significant rise in CTN ≥40% turns out to as an early indicator of tumor progression.
authors.affiliation: From the Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany (RAW, JSS, KL, TH, HH, IG, CR, KH, AKB, CL); Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany (RAW, TH, AKB); FOM University of Applied Sciences, Hamburg, Germany (DOM); and Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA (KH).
authors.forename: R A
authors.initials: RA
authors.lastname: Werner
authors.forename: J S
authors.initials: JS
authors.lastname: Schmid
authors.forename: D O
authors.initials: DO
authors.lastname: Muegge
authors.forename: K
authors.initials: K
authors.lastname: Lückerath
authors.forename: T
authors.initials: T
authors.lastname: Higuchi
authors.forename: H
authors.initials: H
authors.lastname: Hänscheid
authors.forename: I
authors.initials: I
authors.lastname: Grelle
authors.forename: C
authors.initials: C
authors.lastname: Reiners
authors.forename: K
authors.initials: K
authors.lastname: Herrmann
authors.forename: A K
authors.initials: AK
authors.lastname: Buck
authors.forename: C
authors.initials: C
authors.lastname: Lapa
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D002116:Calcitonin / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D018278:Carcinoma, Neuroendocrine / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010880:Piperidines / Q000627:therapeutic use*; D011379:Prognosis; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011799:Quinazolines / Q000627:therapeutic use*; D013964:Thyroid Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D010880:Piperidines; D011799:Quinazolines; D002116:Calcitonin; D011505:Protein-Tyrosine Kinases; C452423:vandetanib