RE: CA 19-9 in Potentially Resectable Pancreatic Cancer: Perspective to Adjust Surgical and Preoperative Therapy

Predicting factors for unresectability in patients with pancreatic ductal adenocarcinoma

“…Previous studies reported that the serum concentrations of CA 19‐9 and CA 125 exhibit significant increases in cases of disseminated carcinoma . In patients with potentially resectable PDAC, the presurgical and postresection CA 19‐9 levels correlate with resectability or overall survival . However, in patients with advanced PDAC, elevated pretreatment levels of CA 19‐9 are associated with adverse patient outcomes .…”

“…The tumor size and the levels of DUPAN‐2 and CA 125 were found to be independent predictors of unresectability. Recently, the prognostic and therapeutic value of the CA 19‐9 level in patients with pancreatic carcinoma treated with resection, radiotherapy and chemotherapy has been reported and is well established . Previous studies reported that the serum concentrations of CA 19‐9 and CA 125 exhibit significant increases in cases of disseminated carcinoma .…”

“…Among these cases, the curative resection rate remains less than 23% . There are many reports describing the prognostic/therapeutic value of carbohydrate antigen (CA) 19‐9 . However, the relationship between the CA 19‐9 level and the resectability of pancreatic ductal adenocarcinoma (PDAC) remains unclear.…”

Advances in Chemotherapy for Pancreatic Cancer

“…[9] However strong data is not available so that one can guide treatment decisions based on the finding of a persistently elevated Ca 19.9. [10] The timing and duration of starting adjuvant chemotherapy was studied in an analysis from the patients enrolled in the ESPAC 3 study. This trial randomised 1,088 patients with resected pancreatic ductal adenocarcinoma to 6 months of postoperative adjuvant treatment with either gemcitabine or leucovorin modulated 5-FU.…”

“…[11] Randomized controlled clinical trials and meta-analyses suggest a significant OS benefit from chemotherapy alone following resection of a pancreatic cancer. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Current standard of care is Gemcitabine alone for 6 months postsurgery given the interpretations from the ESPAC-3 study which showed that though there was not a survival advantage with Gemcitabine compared to 5-FU, toxicities were significantly less with Gemcitabine. [16] Table 1 shows the key studies of adjuvant therapy in pancreatic cancer.…”