The first 2 authors contributed equally to this study.
Carbohydrate antigen 19-9 is a prognostic and predictive biomarker in patients with advanced pancreatic cancer who receive gemcitabine-containing chemotherapy
A pooled analysis of 6 prospective trials
Version of Record online: 11 JUL 2012
Copyright © 2012 American Cancer Society
Volume 119, Issue 2, pages 285–292, 15 January 2013
How to Cite
Bauer, T. M., El-Rayes, B. F., Li, X., Hammad, N., Philip, P. A., Shields, A. F., Zalupski, M. M. and Bekaii-Saab, T. (2013), Carbohydrate antigen 19-9 is a prognostic and predictive biomarker in patients with advanced pancreatic cancer who receive gemcitabine-containing chemotherapy. Cancer, 119: 285–292. doi: 10.1002/cncr.27734
- Issue online: 4 JAN 2013
- Version of Record online: 11 JUL 2012
- Manuscript Accepted: 7 JUN 2012
- Manuscript Revised: 17 MAY 2012
- Manuscript Received: 13 MAR 2012
- carbohydrate antigen 19-9;
Carbohydrate antigen 19-9 (CA19-9) is a widely used biomarker in pancreatic cancer. There is no consensus on the interpretation of the change in CA19-9 serum levels and its role in the clinical management of patients with pancreatic cancer.
Individual patient data from 6 prospective trials evaluating gemcitabine-containing regimens from 3 different institutions were pooled. CA19-9 values were obtained at baseline and after successive cycles of treatment. The objective of this study was to correlate a decline in CA19-9 with outcomes while undergoing treatment.
A total of 212 patients with locally advanced (n = 50) or metastatic (n = 162) adenocarcinoma of the pancreas were included. Median baseline CA19-9 level was 1077 ng/mL (range, 15-492,241 ng/mL). Groups were divided into those levels below (low) or above (high) the median. Median overall survival (mOS) was 8.7 versus 5.2 months (P = .0018) and median time to progression (mTTP) was 5.8 versus 3.7 months (P = .082) in the low versus high groups, respectively. After 2 cycles of chemotherapy, up to a 5% increase versus ≥ 5% increase in CA19-9 levels conferred an improved mOS (10.3 vs 5.1 months, P = .0022) and mTTP (7.5 vs 3.5 months, P = 0.0005).
In patients who have advanced pancreatic cancer treated with gemcitabine-containing regimens baseline CA19-9 is prognostic for outcome. A decline in CA19-9 after the second cycle of chemotherapy is not predictive of improved mOS or mTTP; thus, CA19-9 decline is not a useful surrogate endpoint in clinical trials. Clinically, a ≥ 5% rise in CA19-9 after 2 cycles of chemotherapy serves as a negative predictive marker. Cancer 2013. © 2012 American Cancer Society.