CA19-9 or CEA Decline after the First Cycle of Treatment Predicts Survival in Advanced Biliary Tract Cancer Patients Treated with S-1 and Cisplatin Chemotherapy

Abstract

PurposeWhile tumor markers (carbohydrate antigen 19-9 [CA 19-9] and carcinoembryonic antigen [CEA]) can aid in the diagnosis of biliary tract cancer, their prognostic role has not been clearly elucidated. Therefore, this study was conducted to evaluate the prognostic role of tumor markers and tumor marker change in patients with advanced biliary tract cancer.Materials and MethodsPatients with pathologically proven metastatic or relapsed biliary tract cancer who were treated in a phase II trial of first-line S-1 and cisplatin chemotherapy were enrolled. Serum tumor markers were measured at baseline and after the first cycle of chemotherapy.ResultsAmong a total of 104 patients, 80 (77%) had elevated baseline tumor markers (69 with CA 19-9 elevation and 40 with CEA). A decline ≥ 30% of the elevated tumor marker level after the first cycle of chemotherapy conferred an improved time to progression (TTP), overall survival (OS), and better chemotherapy response. Multivariate analysis revealed tumor marker decline as an independent positive prognostic factor of TTP (adjusted hazard ratio [HR], 0.44; p=0.003) and OS (adjusted HR, 0.37; p < 0.001). Subgroup analysis revealed similar results in each group of patients with CA 19-9 elevation and CEA elevation. In addition, elevated baseline CEA was associated with poor survival in both univariate and multivariate analysis.ConclusionTumor marker decline was associated with improved survival in biliary tract cancer. Measuring tumor marker after the first cycle of chemotherapy can be used as an early assessment of treatment outcome.

Therapeutic outcomes and prognostic factors in unresectable gallbladder cancer treated with gemcitabine plus cisplatin

“…Likewise, Park et al [23] recently reported that CEA independently predicts prognosis in patients with metastatic BTC. Consistent with previous studies [23, 24], the results of our study demonstrated that baseline CA 19–9 and CEA level were independent prognostic markers.…”

Evaluation of Tumor Markers and Their Impact on Prognosis in Gallbladder, Bile Duct and Cholangiocellular Carcinomas – A Pilot Study

“…Another recent study with patients suffering from advanced and inoperable bile duct cancers (212 patients in the investigational cohort and 677 patients in tree independent validation cohorts) showed that the decline of CA 19-9 serum level during chemotherapy was predictive for longer OS (HR=0.60, 95%CI=0.44-0.80, p<0.0005) (16). Similarly, the decline of CA19-9 and CEA ≥30% after the first cycle of S-1 and cisplatin chemotherapy in 104 patients with metastatic or relapsed biliary tract cancers served as a positive prognostic factor of time to progression (HR=0.44, p=0.003) as well as OS (HR=0.37, p<0.001) in the multivariate analysis (17). In another recent study with biliary tract cancer patients undergoing resection with curative intent, the worse 3-year OS was observed among patients with an abnormally high (≥37 U/ml) preoperative as well as postoperative CA19-9 levels by comparison with those with either the high preoperative and normal postoperative CA19-9 levels, or normal preoperative CA19-9 level (3-year OS rate 31, 73, and 70.4% respectively, p<0.001) (18).…”

Neoadjuvant Intraperitoneal Chemotherapy in Patients with Pseudomyxoma Peritonei—A Novel Treatment Approach

“…In a study of 26 patients with advanced gastric cancer and with elevation of at least one of the three tumor makers (CEA, CA 19.9, CA 125) before starting systemic chemotherapy, the authors demonstrated a significant difference in survival amongst responders (assessed by drop in tumor markers levels) as compared to non-responders (p = 0.0056) [22]. Similarly, Lee et al demonstrated that the decrease in the tumor marker level after chemotherapy was associated with improved survival in advanced biliary tract cancer patients [23]. They reported tumor marker decline as an independent positive prognostic factor for improved time to progression (TTP) (adjusted HR 0.44; p = 0.03) and overall survival (adjusted HR 0.37; p = 0.001) in these patients after the first cycle of chemotherapy [23].…”

“…Similarly, Lee et al demonstrated that the decrease in the tumor marker level after chemotherapy was associated with improved survival in advanced biliary tract cancer patients [23]. They reported tumor marker decline as an independent positive prognostic factor for improved time to progression (TTP) (adjusted HR 0.44; p = 0.03) and overall survival (adjusted HR 0.37; p = 0.001) in these patients after the first cycle of chemotherapy [23]. In our study, we were able to demonstrate an absolute decline in CEA levels after treatment with neoadjuvant IP chemotherapy, although a survival benefit is yet to be determined.…”