Can carcinoembryonic antigen replace computed tomography in response evaluation of metastatic colorectal cancer?

Hermunen, Kethe; Lantto, Eila; Poussa, Tuija; Haglund, Caj; Österlund, Pia

doi:10.1080/0284186x.2018.1431400

Cited by 9 publications

(13 citation statements)

References 27 publications

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“…One of the most important factors in the analysis of tumour marker utilization for monitoring response, the cut-off value, did not influence concordance with radiology-based response evaluation. The importance of any change in the CEA value, as reported by Hermunen et al [ 32 ], appears overly optimistic, as CEA values fluctuate for several reasons unrelated to the tumour response and many different cut-off values have been obtained using several methods[ 30 - 33 , 39 - 55 ], which can lead to significant differences in the statistical analysis. The question of how to interpret tumour marker changes in practice remains unresolved.…”

Section: Discussionmentioning

confidence: 99%

“…We performed a linear correlation method to evaluate the relationship between the RECIST response and changes in tumour markers and inflammatory indices. Several studies have published data about the correlation between tumour response and CEA kinetics[ 31 , 32 , 33 ] indicating a significant correlation, while Hermunen et al [ 32 ] separately analysed the correlation coefficient every 2 mo of treatment, showing variation from 0.37-0.47. In our study, there was a significant moderate correlation between CEA kinetics and both the RECIST 1.1 and the dichotomous RECIST 1.1 outcomes (PD, DC).…”

Section: Discussionmentioning

confidence: 99%

“…Petrioli et al [ 46 ] found that a CEA increase of more than 50% identified PD with an Sp of 96.4%. According to Hermunen et al [ 32 ]’s study, increasing CEA levels could identify all patients with PD [(Se) = 1.0], and in 50%-74% of these patients, an increasing CEA level predicted PD earlier than CT. It was possible to replace CT with CEA monitoring in all patients with decreasing CEA levels, meaning that 23%-47% of CT scans could have been avoided at any given time point[ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Dynamic monitoring of carcinoembryonic antigen, CA19-9 and inflammation-based indices in patients with advanced colorectal cancer undergoing chemotherapy

Manojlovic¹,

Savić²,

Nikolic³

et al. 2022

WJCC

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BACKGROUND The roles of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) in monitoring the patient response to chemotherapy for metastatic colorectal cancer (mCRC) are not clearly defined, and inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII), have been sparsely investigated for this purpose. AIM To aim of this study was to evaluate the relationship between the kinetics of CEA, CA19-9, NLR, LMR, PLR and SII in serum and patient response to chemotherapy estimated by computed tomography (CT) in patients with unresectable mCRC. METHODS Patients with mCRC treated with a 1 st -line and 2 nd -line chemotherapy underwent at least 3 whole-body spiral CT scans during response monitoring according to the Response Evaluation Criteria in Solid Tumour 1.1 (RECIST 1.1), and simultaneous determination of CEA, CA19-9, neutrophil, lymphocyte, platelet and monocyte levels was performed. The kinetics of changes in the tumour markers and inflammatory indices were calculated as the percentage change from baseline or nadir, while receiver operating characteristic curves were drawn to select the thresholds to define patients with progressive or responsive disease with the highest sensitivity (Se) and specificity (Sp). The correlation of tumour marker kinetics with inflammatory index changes and RECIST response was determined by univariate and multivariate logistic regression analysis and the clinical utility index (CUI). RESULTS A total of 102 patients with mCRC treated with chemotherapy were included. Progressive disease (PD), defined as a CEA increase of 25.52%, resulted in an Se of 80.3%, an Sp of 84%, a good CUI negative [CUI (Ve-)] value of 0.75 and a good fraction correct (FC) value of 81.2; at a CEA cut-off of -60.85% with an Se of 100% and an Sp of 35.7% for PD, CT could be avoided in 25.49% of patients. The 21.49% CA19-9 cut-off for PD had an Se of 66.5%, an Sp of 87.4%, an acceptable CUI (Ve-) value of 0.65 and an acceptable FC value of 75. An NLR increase of 11.5% for PD had an Se of 67% and an Sp of 66%; a PLR increase of 5.9% had an Se of 53% and an Sp of 69%; an SII increase above -6.04% had an Se of 72% and an Sp of 63%; and all had acceptable CUI (Ve-) values at 0.55. In the univariate logistic regression analysis, CEA ( P < 0.001), CA19-9 ( P < 0.05), NLR ( P < 0.05), PLR ( P < 0.05) and SII ( P < 0.05) were important predictors of tumour progression, but in the multivariate logistic regression analysis, CEA was the only independent predictor of PD ( P < 0.05). CONCLUSION CEA is a useful marker for monitoring the chemothera...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dynamic monitoring of carcinoembryonic antigen, CA19-9 and inflammation-based indices in patients with advanced colorectal cancer undergoing chemotherapy

Manojlovic¹,

Savić²,

Nikolic³

et al. 2022

WJCC

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“…CEA has been the hallmark of blood borne biomarkers for patients with mCRC for decades, although the routinely use of CEA plays a minor role in current guidelines (7,22,23). For patients with CRCLM, CEA has been widely studied in patients undergoing surgical resection of liver metastases and well established as a prognostic marker for survival (4), yet a predictive value of CEA for any loco-regional treatment has never been established.…”

Section: Discussionmentioning

confidence: 99%

Prognostic and predictive value of circulating DNA for hepatic arterial infusion of chemotherapy for patients with colorectal cancer liver metastases

et al. 2020

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Hepatic arterial infusion (HAI) of chemotherapy is an experimental treatment option for patients with colorectal cancer liver metastases (CRCLM). The current study aimed to investigate the predictive and prognostic value of cell free DNA (cfDNA) in patients with CRCLM receiving HAI with oxaliplatin and systemic capecitabine. Plasma samples from 62 patients were investigated who were included into a single arm phase II study investigating HAI treatment for patients with CRCLM. The clinical outcome of the trial has been presented previously. In brief, treatment consisted of intrahepatic infusion of oxaliplatin 100 mg/m 2 every second week with concomitant oral capecitabine 3,500 mg/m 2 every second week for up to 12 cycles. Blood samples were drawn at baseline and follow-up and plasma was analyzed for cell free DNA using a direct fluorescent assay. The baseline level of plasma cfDNA was 0.92 ng/µl (95% CI 0.84-1.00). Patients with a baseline value of cfDNA above the 75th quartile had a median overall survival of 2.4 years (95% CI 0.7-2.8), compared with 3.9 years (95% CI 2.8-5.9) for patients below the 75th quartile (P=0.02). The baseline level of cfDNA was significantly lower (0.91 ng/µl, 95% CI 0.76-0.98) in patients who achieved an objective response compared to non-responders (1.79 ng/µl; 95% CI 0.99-2.57; P=0.02). The current study demonstrated a possible prognostic and predictive value of cfDNA for patients with CRCLM undergoing HAI with oxaliplatin and concomitant capecitabine.

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“…[50][51][52]), no clinically valuable marker is yet available. Bevacizumab may also induce pseudoprogression, complicating the response evaluation [53], telling that other ways of evaluating response may be important [54].…”

Section: Should Bevacizumab In the Absence Of Clear Contraindicationsmentioning

confidence: 99%

Do we make progress in elderly patients with metastatic colorectal cancer?

Glimelius

Pfeiffer

2018

Acta Oncologica

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Can carcinoembryonic antigen replace computed tomography in response evaluation of metastatic colorectal cancer?

Abstract: When the CEA level at a certain measuring point is the same or lower than CEA at baseline or at nadir (the measuring point with the lowest CEA value) during treatment, CEA can replace CT.

Cited by 9 publications

References 27 publications

Dynamic monitoring of carcinoembryonic antigen, CA19-9 and inflammation-based indices in patients with advanced colorectal cancer undergoing chemotherapy

Dynamic monitoring of carcinoembryonic antigen, CA19-9 and inflammation-based indices in patients with advanced colorectal cancer undergoing chemotherapy

Prognostic and predictive value of circulating DNA for hepatic arterial infusion of chemotherapy for patients with colorectal cancer liver metastases

Do we make progress in elderly patients with metastatic colorectal cancer?

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