Abstract
In this retrospective study, we investigated whether the kinetic change of serum carcinoembryonic antigen (CEA) levels can be an early indicator for the progression in metastatic non-small cell lung cancer (NSCLC) patients during maintenance therapy with bevacizumab plus pemetrexed. Ten patients diagnosed with metastatic lung adenocarcinoma who received a first-line therapy including bevacizumab-based chemotherapy and a following maintenance therapy including bevacizumab plus pemetrexed from June 2015 to October 2016 were recruited in this study. During the maintenance treatment, patients’ CEA levels all elevated at or after the first cycle of maintenance treatment with a median CEA elevation-free survival time as 17.7 days, which was far more shorter than the median progression-free survival time evaluated by CT imaging specially for maintenance treatment (102.2 days). Before the disease progressed, the values of CEA increased steadily for several cycles with the response evaluation still as stable disease, indicating that the changes of CEA level would be earlier and more sensitive for detection of progression. The CEA kinetic was calculated with a mean of 9.6451 and a median of 8.0135, which sensitively reflected the increasing rate of CEA levels at an early stage. Our study showed that the kinetic change of CEA could be an early predictor for the progression in metastatic NSCLC patients during maintenance therapy.
Highlights
Accounting for >80% of primary lung cancers, nonsmall-cell lung cancer (NSCLC) is a leading cause of cancer-related mortality all around the world [1]
We investigated whether the kinetic change of serum carcinoembryonic antigen (CEA) levels can be an early indicator for the progression in metastatic non-small cell lung cancer (NSCLC) patients during maintenance therapy with bevacizumab plus pemetrexed
Guidelines recommend bevacizumab plus chemotherapy as the preferred first-line treatment option and bevacizumab with pemetrexed as the standard maintenance treatment strategy. This has been proved efficacious for patients, a substantial fraction of patients were resistant to vascular endothelial growth factor (VEGF) based therapies within a limited duration of time, especially during the maintenance treatment [4]
Summary
Accounting for >80% of primary lung cancers, nonsmall-cell lung cancer (NSCLC) is a leading cause of cancer-related mortality all around the world [1]. Patients with advanced non-squamous NSCLC have especially poor prognosis, with only 4–6 months median progressionfree survival (PFS) and 8–10 months median overall survival (OS) [2, 3]. For this group of patients, NCCN guidelines recommend bevacizumab plus chemotherapy as the preferred first-line treatment option and bevacizumab with pemetrexed as the standard maintenance treatment strategy. This has been proved efficacious for patients, a substantial fraction of patients were resistant to vascular endothelial growth factor (VEGF) based therapies within a limited duration of time, especially during the maintenance treatment [4]. As a consequence, during the maintenance treatment with bevacizumab plus pemetrexed, the main challenge is to identify the disease progression at an early stage using a simple and sensitive method to optimize treatment strategy for metastatic NSCLC patients
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