P-119 - Prognostic value of CA 19-9 kinetics during gemcitabine-based chemotherapy in patients with advanced cholangiocarcinoma

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anticancer agents
Hepatobiliary Cancers
Translational Research
Basic Principles in the Management and Treatment (of cancer)
Therapy
Biological therapy
Presenter S.H. Lee
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors S.H. Lee1, B.S. Lee2, J. Ryu3, Y.-. Kim1
  • 1Seoul National University College of Medicine, Seoul/KR
  • 2Kyungpook National University College of Medicine, Daegu/KR
  • 3Seoul National University Hospital, Seoul/KR

Abstract

Introduction

Little is known of the prognostic value of CEA/CA19-9 kinetics during chemotherapy in patients with advanced cholangiocarcinoma (CCA). The aim of this study was to evaluate the association between the change in CEA and CA 19-9 level during gemcitabine-based chemotherapy and survival in patients with advanced CCA.

Methods

A total of 236 patients with pathologically-confirmed advanced CCA received gemcitabine-based chemotherapy were reviewed, and 179 were eligible for analysis. Baseline, pre-, and post-treatment (after two cycles of chemotherapy) CEA and CA 19-9 values were checked, and survival was compared according to various cutting points of baseline measurement or extent of change of tumor marker level.

Results

Patients with a ≥ 50% decline in CA 19-9 level had better survival than the others (16.0 vs. 9.0 months). However, CEA decline did not predict survival gain. Significant prognostic factors of survival in multivariable analysis included ≥ 50% decline in CA 19-9 level (HR 0.48), distal location of tumor (HR 0.50), and baseline CA 19-9 level ≤ 1000 U/ml (HR 0.53). Subgroup analysis was conducted in 114 patients with pre-treatment CA 19-9 > 37 U/ml and bilirubin ≤ 2 mg/dL. Decline ≥ 50% in CA 19-9 level still showed an independent prognostic significance (HR 0.42).

Conclusion

CA19-9 but not CEA kinetics serves as a predictor of better survival in patients with advanced CCA on gemcitabine-based chemotherapy. A ≥ 50% decline in CA 19-9 level after two cycles of chemotherapy may have clinical utility as an early indicator of better response to gemcitabine-based chemotherapy.