P-0203 - Value of monitoring CEA in patients with colon cancer receiving adjuvant chemotherapy

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Biomarkers
Colon Cancer
Presenter Andrea Nagy
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors A. Nagy, S. Taylor, R. Kulkarni
  • Royal Derby Hospital, Derby/UK

Abstract

Introduction

Carcinoembryonic antigen (CEA) is a glycoprotein which is used as biomarker for monitoring disease response to chemotherapy in metastatic colorectal cancer and follow up of patients. In general a rising of CEA level may mean tumor progression, but a transient increase (surge phenomenon or flare) was found to be associated with a clinical benefit in patients receiving first line chemotherapy for metastatic colorectal cancer (1). The aim of this study was to evaluate the correlation between the trend of CEA levels and development of early recurrence or metastatic disease in patients with colon cancer receiving adjuvant chemotherapy.

Methods

We retrospectively reviewed 82 patients with Dukes' stage B and C colon cancer who underwent at least 4 cycles of adjuvant chemotherapy from July 2010 to July 2012. Patients had regular CEA assessment before, during and after completion of chemotherapy. Patients were divided into five groups according to baseline CEA level and CEA kinetic: normal and stabile (NS- 46), normal and increasing (NI-8), elevated and increasing (EI-6), normal and transient increase (NTI-18), elevated and stabile (ES-4). Patients' age, site of primary tumour, type of surgery, type of adjuvant chemotherapy, sites of recurrence and metastases were also recorded.

Results

15 patients (NS-3, NI-4, EI-2, NTI-3, ES-3) developed early recurrence or metastatic disease over the follow up period of 1-2 years following completion of chemotherapy and only 1 (ES) developed recurrence while receiving chemotherapy. Majority of these patients (87.5%) had elevated CEA level and Dukes' C disease (81%). The transient CEA increase usually started between 2-4 cycles and resolved 1-2 months following completion of chemotherapy. 6 out of 38 patients with rising CEA underwent scans during and following chemotherapy which did not show disease recurrence or metastases.

Conclusion

CEA is over expressed in malignant tumors and also increased in certain benign conditions. There is evidence showing that administration of more than 6 cycles of neoadjuvant chemotherapy (oxaliplatin) increased the risk of developing chemotherapy associated pathological changes of liver parenchyma in patients with colorectal cancer (2). The chemotherapy probably causes liver parenchymal changes and may cause transient increase of CEA with the same mechanism in the adjuvant settings. In our group transient CEA increase was noted in 18 patient (21.2%) and 3 of them (16.7%) subsequently developed recurrence and or metastases compared to only 3 out of 47 (6%) in the group with normal CEA. Overall elevated CEA level predicted recurrent and metastatic disease in a significant proportion of patients. Reference:

1. The impact of carcinoembryonic antigen flare in patients with advanced colorectal cancer receiving first-line chemotherapy. A S Strimpakos, D Cunningham, C Mikropoulos, I Petkar, Y Barbachano, I Chau, Department of Medicine, Royal Marsden Hospital, London and Surrey, UK. Annals of Oncology 10/2009; 21(5):1013-9.

2. Chemotherapy before liver resection of colorectal metastases: friend or foe? Kuno Lehmann, Andreas Rickenbacher, Achim Weber, Bernhard C Pestalozzi, Pierre-Alain Clavien, Swiss Hepato-Pancreato-Biliary (HPB) Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland. Annals of surgery 02/2012; 255(2):237-47.