title: Baseline and On-Treatment Markers Determining Prognosis of First-Line Chemotherapy in Combination with Bevacizumab in Patients with Metastatic Colorectal Cancer.
abstract: BACKGROUND
  In metastatic colorectal cancer, no upfront or on-treatment markers are available to determine the prognosis or efficacy for chemotherapy in combination with bevacizumab.
  
  
  METHODS
  The current analysis was performed to evaluate the prognostic value of disease and patient characteristics (age, number of metastatic sites, stage of primary tumor, performance status, carcinoembryonic antigen (CEA)) and on-treatment changes of CEA (response after 8-12 weeks of treatment and specific patterns of CEA kinetics) in patients from an observational cohort study of chemotherapy with bevacizumab.
  
  
  RESULTS
  Baseline factors were available from 1,438 patients. Patients with baseline CEA levels > 20 ng/ml, more than 1 metastatic site, and age > 75 years showed significantly lower progression-free (PFS) and overall survival in multivariate analysis. A CEA response of > 30% during treatment was associated with increased PFS. In addition, the pattern of CEA kinetics predicts survival and response to treatment.
  
  
  CONCLUSIONS
  In summary, baseline CEA, number of metastatic sites, and age are strong independent prognostic factors for survival. By monitoring CEA, clear patterns with distinct prognostic value can be determined. CEA kinetics and/or response after 8-12 weeks might be a useful and simple tool to stratify the post-induction treatment approach based on individual prognosis in the future.
authors.affiliation: Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Quidde
authors.forename: Laura
authors.initials: L
authors.lastname: Denne
authors.forename: Andreas
authors.initials: A
authors.lastname: Kutscheidt
authors.forename: Manfred
authors.initials: M
authors.lastname: Kindler
authors.forename: Andreas
authors.initials: A
authors.lastname: Kirsch
authors.forename: Melanie
authors.initials: M
authors.lastname: Kripp
authors.forename: Volker
authors.initials: V
authors.lastname: Petersen
authors.forename: Matthias
authors.initials: M
authors.lastname: Schulze
authors.forename: Jörg
authors.initials: J
authors.lastname: Seraphin
authors.forename: Dirk
authors.initials: D
authors.lastname: Tummes
authors.forename: Dirk
authors.initials: D
authors.lastname: Arnold
authors.forename: Alexander
authors.initials: A
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D000068258:Bevacizumab / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002272:Carcinoembryonic Antigen; D000068258:Bevacizumab