P-0114 - CA 19-9 Related Tumor Growth Rate After First Line Chemotherapy of Advanced Pancreatic Cancer

Abstract

Introduction: The absolute value of carbohydrate antigen 19-9 (CA 19-9) pre-treatment and the reduction after chemotherapy are established prognostic factors for patients with advanced pancreatic cancer undergoing cytotoxic chemotherapy. In particular, a CA 19-9 decline of >25% after the first two cycles of chemotherapy was predictive for TTP and OS. A specific growth rate has been calculated in other neoplasms on the serial measurements of radiologic diameters of metastases or on the serum determinations of cancer markers. The present study is a retrospective mono-institutional evaluation of the prognostic role of CA 19-9 reduction (RR) [Haas et al. 2013; J Cancer Res Clin Oncol 139: 681-9] and CA 19-9 related tumor growth rate constant (G) [Mehrara et al. 2007; Cancer Res 67: 3970-5], after 2 cycles of chemotherapy.Methods: Patients were selected from a mono-institutional series of patients with locally advanced unresectable or metastatic pancreatic cancer, who received a first-line systemic chemotherapy, which has been excluded for a subsequent surgery or radiotherapy. For the present analysis patients were required to have at least three CA 19-9 measurements: time-1 at the beginning of chemotherapy, time-2 after the 2nd cycle, time-3 after at least one additional month or after serologic progression.Results: 33 patients met the selection criteria, 18 males and 15 females, with ECOG PS 0-1, median age 67 (range 46-81), with cancer of the pancreatic head vs. body/tail (18 vs. 15). Ten had only loco-regional disease and 23 metastatic, 11 had undergone previous surgery with radical intent and 5 received adjuvant chemotherapy. First-line chemotherapy of the 33 patients was as follows: gemcitabine 10, GEMOX 9, FOLFIRINOX 8, fluoropyrimidine 6. Median OS was 7.1 months. Patients with a RR (17) showed a median OS of 11.4 vs. 5.1 mos. The median baseline CA 19-9 was 302 U/mL: patients with baseline CA 19-9 <302 U/mL (17 vs. 16) had better median OS (9.3 vs. 6.0 mos; p = 0.038). The median value of G was -2.4: patients with G <-2.4 (16 vs 17) had better median OS (10.2 vs. 5.7 mos; p = 0.005).Conclusion: Even in a small retrospective case series CA 19-9 baseline value and RR confirmed their prognostic role after first-line chemotherapy. G is also related with OS, similar to RR, but with the advantage that it can be further recalculated at disease progression, capturing more clearly the time of serologic progression. Introduction: The absolute value of carbohydrate antigen 19-9 (CA 19-9) pre-treatment and the reduction after chemotherapy are established prognostic factors for patients with advanced pancreatic cancer undergoing cytotoxic chemotherapy. In particular, a CA 19-9 decline of >25% after the first two cycles of chemotherapy was predictive for TTP and OS. A specific growth rate has been calculated in other neoplasms on the serial measurements of radiologic diameters of metastases or on the serum determinations of cancer markers. The present study is a retrospective mono-institutional evaluation of the prognostic role of CA 19-9 reduction (RR) [Haas et al. 2013; J Cancer Res Clin Oncol 139: 681-9] and CA 19-9 related tumor growth rate constant (G) [Mehrara et al. 2007; Cancer Res 67: 3970-5], after 2 cycles of chemotherapy. Methods: Patients were selected from a mono-institutional series of patients with locally advanced unresectable or metastatic pancreatic cancer, who received a first-line systemic chemotherapy, which has been excluded for a subsequent surgery or radiotherapy. For the present analysis patients were required to have at least three CA 19-9 measurements: time-1 at the beginning of chemotherapy, time-2 after the 2nd cycle, time-3 after at least one additional month or after serologic progression. Results: 33 patients met the selection criteria, 18 males and 15 females, with ECOG PS 0-1, median age 67 (range 46-81), with cancer of the pancreatic head vs. body/tail (18 vs. 15). Ten had only loco-regional disease and 23 metastatic, 11 had undergone previous surgery with radical intent and 5 received adjuvant chemotherapy. First-line chemotherapy of the 33 patients was as follows: gemcitabine 10, GEMOX 9, FOLFIRINOX 8, fluoropyrimidine 6. Median OS was 7.1 months. Patients with a RR (17) showed a median OS of 11.4 vs. 5.1 mos. The median baseline CA 19-9 was 302 U/mL: patients with baseline CA 19-9 <302 U/mL (17 vs. 16) had better median OS (9.3 vs. 6.0 mos; p = 0.038). The median value of G was -2.4: patients with G <-2.4 (16 vs 17) had better median OS (10.2 vs. 5.7 mos; p = 0.005). Conclusion: Even in a small retrospective case series CA 19-9 baseline value and RR confirmed their prognostic role after first-line chemotherapy. G is also related with OS, similar to RR, but with the advantage that it can be further recalculated at disease progression, capturing more clearly the time of serologic progression.