P-0114 - CA 19-9 related tumor growth rate after first line chemotherapy of advanced pancreatic cancer

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Biomarkers
Pancreatic Cancer
Presenter Giuseppe Colloca
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors G. Colloca, A. Venturino, Z. Coccorullo, D. Guarneri, G. Caltabiano, G. Addamo, R. Ratti, L. Repetto
  • “G. Borea” Hospital, Sanremo/IT

Abstract

Introduction

The absolute value of carbohydrate antigen 19-9 (CA 19-9) pre-treatment and the reduction after chemotherapy are established prognostic factors for patients with advanced pancreatic cancer undergoing cytotoxic chemotherapy. In particular, a CA 19-9 decline of >25% after the first two cycles of chemotherapy was predictive for TTP and OS. A specific growth rate has been calculated in other neoplasms on the serial measurements of radiologic diameters of metastases or on the serum determinations of cancer markers. The present study is a retrospective mono-institutional evaluation of the prognostic role of CA 19-9 reduction (RR) [Haas et al. 2013; J Cancer Res Clin Oncol 139: 681-9] and CA 19-9 related tumor growth rate constant (G) [Mehrara et al. 2007; Cancer Res 67: 3970-5], after 2 cycles of chemotherapy.

Methods

Patients were selected from a mono-institutional series of patients with locally advanced unresectable or metastatic pancreatic cancer, who received a first-line systemic chemotherapy, which has been excluded for a subsequent surgery or radiotherapy. For the present analysis patients were required to have at least three CA 19-9 measurements: time-1 at the beginning of chemotherapy, time-2 after the 2nd cycle, time-3 after at least one additional month or after serologic progression.

Results

33 patients met the selection criteria, 18 males and 15 females, with ECOG PS 0-1, median age 67 (range 46-81), with cancer of the pancreatic head vs. body/tail (18 vs. 15). Ten had only loco-regional disease and 23 metastatic, 11 had undergone previous surgery with radical intent and 5 received adjuvant chemotherapy. First-line chemotherapy of the 33 patients was as follows: gemcitabine 10, GEMOX 9, FOLFIRINOX 8, fluoropyrimidine 6. Median OS was 7.1 months. Patients with a RR (17) showed a median OS of 11.4 vs. 5.1 mos. The median baseline CA 19-9 was 302 U/mL: patients with baseline CA 19-9 <302 U/mL (17 vs. 16) had better median OS (9.3 vs. 6.0 mos; p = 0.038). The median value of G was -2.4: patients with G <-2.4 (16 vs 17) had better median OS (10.2 vs. 5.7 mos; p = 0.005).

Conclusion

Even in a small retrospective case series CA 19-9 baseline value and RR confirmed their prognostic role after first-line chemotherapy. G is also related with OS, similar to RR, but with the advantage that it can be further recalculated at disease progression, capturing more clearly the time of serologic progression.