Are serial CA 19-9 kinetics helpful in predicting survival in patients with advanced or metastatic pancreatic cancer treated with gemcitabine and cisplatin?

被引:53
作者
Stemmler, J
Stieber, P
Szymala, AM
Schalhorn, A
Schermuly, MM
Wilkowski, R
Helmberger, T
Lamerz, R
Stoffregen, C
Niebler, K
Garbrecht, M
Heinemann, V
机构
[1] Onkol Klin Bad Trissl, Dept Oncol, Oberaudorf, Germany
[2] Univ Munich, Dept Clin Chem, D-80539 Munich, Germany
[3] Univ Munich, Dept Internal Med Oncol 3, D-80539 Munich, Germany
[4] Univ Munich, Dept Radiotherapy & Radiooncol, D-80539 Munich, Germany
[5] Univ Munich, Dept Radiol, D-80539 Munich, Germany
[6] Univ Munich, Dept Internal Med 2, D-80539 Munich, Germany
[7] Lilly Deutschland GmbH, Bad Homburg, Germany
[8] Clin Munchen Neuperlach, Dept Internal Med Oncol, Munich, Germany
来源
ONKOLOGIE | 2003年 / 26卷 / 05期
关键词
CA; 19-9; tumor marker; combination therapy : gemcitabine; cisplatin; pancreatic cancer;
D O I
10.1159/000072980
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Serial kinetics of serum CA 19-9 levels have been reported to reflect response and survival in patients with pancreatic cancer undergoing surgery, radiotherapy, and chemotherapy. We prospectively studied serial kinetics of serum CA 19-9 levels of patients with locally advanced or metastatic disease treated with gemcitabine and cisplatin. Patients and Methods: Enrolled in the study were 87 patients (female/male = 26/61; stage III/IV disease = 24/63). Patients received gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 plus cisplatin 50 mg/m(2) on days 1 and 15, every 4 weeks. Serum samples were collected at the onset of chemotherapy and before the start of a new treatment cycle (day 28). Results: 77 of 87 patients (88.5%) with initially elevated CA 19-9 levels were included for evaluation. According to imaging criteria, 4 (5.2%) achieved a complete remission and 11 (14.3%) achieved partial remission, yielding an overall response rate of 19.5%. 43 (55.8%) patients were CA 19-9 responders, defined by greater than or equal to50% decrease in CA 19-9 serum levels within 2 months after treatment initiation. Except for one, all patients who had responded by imaging criteria (n = 14) fulfilled the criterion of a CA 19-9 responder. Despite being characterized as non-responders by CT-imaging criteria (stable/progressive disease), 29 patients were classified as CA 19-9 responders (positive predictive value 32.5%). Independent of the response evaluation by CT, CA 19-9 responders survived significantly longer than CA 19-9 non-responders (295 d; 95% CI: 285-445 vs. 174 d; 95% CI: 134-198; p = 0.022). Conclusion: CA 19-9 kinetics in serum serve as an early and reliable indicator of response and help to predict survival in patients with advanced pancreatic cancer receiving effective treatment with gemcitabine and cisplatin.
引用
收藏
页码:462 / 467
页数:6
相关论文
共 25 条
[1]  
Ahlgren JD, 1996, CANCER-AM CANCER SOC, V78, P654
[2]   COMPREHENSIVE CRITERIA FOR ASSESSING THERAPY-INDUCED TOXICITY [J].
AJANI, JA ;
WELCH, SR ;
RABER, MN ;
FIELDS, WS ;
KRAKOFF, IH .
CANCER INVESTIGATION, 1990, 8 (02) :147-159
[3]   PANCREATIC AND AMPULLARY CARCINOMA - ULTRASOUND, COMPUTED-TOMOGRAPHY, MAGNETIC-RESONANCE-IMAGING AND ANGIOGRAPHY [J].
BRAMBS, HJ ;
CLAUSSEN, CD .
ENDOSCOPY, 1993, 25 (01) :58-68
[4]   Phase II study of gemcitabine in combination with cisplatin in patients with locally advanced and/or metastatic pancreatic cancer [J].
Brodowicz, T ;
Wolfram, RM ;
Köstler, WJ ;
Tomek, S ;
Vaclavik, I ;
Steger, GG ;
Teleky, B ;
Függer, R ;
Jakesz, R ;
Zielinski, CC .
ANTI-CANCER DRUGS, 2000, 11 (08) :623-628
[5]   Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: A randomized trial [J].
Burris, HA ;
Moore, MJ ;
Andersen, J ;
Green, MR ;
Rothenberg, ML ;
Madiano, MR ;
Cripps, MC ;
Portenoy, RK ;
Storniolo, AM ;
Tarassoff, P ;
Nelson, R ;
Dorr, FA ;
Stephens, CD ;
VanHoff, DD .
JOURNAL OF CLINICAL ONCOLOGY, 1997, 15 (06) :2403-2413
[6]   Are serial measurements of CA19-9 useful in predicting response to chemotherapy in patients with inoperable adenocarcinoma of the pancreas? [J].
Gogas, H ;
Lofts, FJ ;
Evans, TRJ ;
Daryanani, S ;
Mansi, JL .
BRITISH JOURNAL OF CANCER, 1998, 77 (02) :325-328
[7]  
Halm U, 2000, BRIT J CANCER, V82, P1013
[8]  
Heinemann V, 1999, ANTICANCER RES, V19, P2433
[9]   Gemcitabine: Progress in the treatment of pancreatic cancer [J].
Heinemann, V .
ONCOLOGY, 2001, 60 (01) :8-18
[10]   Gemcitabine and cisplatin in the treatment of advanced or metastatic pancreatic cancer [J].
Heinemann, V ;
Wilke, H ;
Mergenthaler, HG ;
Clemens, M ;
König, H ;
Illiger, HJ ;
Arning, M ;
Schalhorn, A ;
Possinger, K ;
Fink, U .
ANNALS OF ONCOLOGY, 2000, 11 (11) :1399-1403