British Journal of Cancer, levels of the tumor marker CA 19-9 may provide a more accurate prediction of a patient’s long-term outcomes following surgery than the more commonly used assessments.
The pancreas is an organ that is surrounded by the stomach, small intestine, bile ducts (tubes that connect the liver to the small intestine), gallbladder, liver and spleen. The pancreas helps the body to break down food and produces hormones, such as insulin, to regulate the body’s storage and use of food. For patients whose disease has not spread to distant sites in the body, surgical removal of the cancer typically results in optimal long-term outcomes; however, long-term survival or a cure are rarely achieved for patients with pancreatic cancer. The standard chemotherapy agent used to treat pancreatic cancer is Gemzar®. Due to the poor outcomes associated with current treatment for patients with pancreatic cancer, recent research efforts have been focused on evaluating new therapeutic approaches alone or in combination with other treatment modalities in order to improve survival for patients with this disease.
Researchers commonly use a series of clinical assessments to determine responses to treatment in patients with pancreatic cancer. These assessments typically include improvement in pain control, weight loss or maintenance, the ability to perform daily tasks and regression of cancer size as revealed by scans. Recently, however, it has been noted that the tumor marker CA 19-9 may be an important determinant in the prediction of long-term outcomes following therapy in patients with pancreatic cancer.
2,3,4 CA (cancer antigen) 19-9 is a small carbohydrate that can be found in circulating blood, with high levels indicative of pancreatic cancer. Results from recent clinical trials have indicated that CA 19-9 may be an accurate marker that could prove useful in predicting outcomes of patients with pancreatic cancer when added to the standard clinical assessments.
Recently, researchers from Europe conducted a clinical trial to evaluate the accuracy of CA 19-9 in monitoring responses in patients with pancreatic cancer. This trial involved 46 patients with advanced pancreatic cancer who were treated with Gemzar®. According to results from scans, 2 patients achieved a complete disappearance of detectable cancer, 5 patients had partial anti-cancer responses and 19 patients had disease stabilization. However, patients whose level of CA 19-9 declined by 20% or more had a significantly greater average duration of survival, compared to their matched counterparts whose CA 19-9 levels did not decline by at least 20%. Upon analysis of several different variables involving the cancer, treatment response and patient variables, levels of CA 19-9 proved to be the most important determinant in predicating survival.
The researchers concluded that CA 19-9 levels may be very useful in determining a true clinical response in the treatment of pancreatic cancer, and may ultimately be added as a standard assessment variable for these patients. Patients not demonstrating a specific reduction in CA 19-9 levels following treatment may be considered for a more aggressive and/or novel treatment approach. Patients with pancreatic cancer may wish to speak with their physician about obtaining CA 19-9 levels or participating in a clinical trial further evaluating markers.
1.Ziske C, Schlie C, Gorschluter M, et al. Prognostic Value of CA 19-9 Levels in Patients with Inoperable Adenocarcinoma of the Pancreas Treated with Gemcitabine.
British Journal of Cancer. 2003;89:1413-1417.
2.Montgomery RC, Hoffman JP, Riley LB et.al.: Prediction of recurrence and survival by post-resection CA 19-9 values in patients with adenocarcinoma of the pancreas.
Annals of Surgical Oncology. 4: 55-556, 1997.
3.Ko A, Renshw FG, Hwang J, et al.: Prognostic value of CA19-9 in patients with advanced pancreatic cancer receiving fixed-dose rate gemcitabine. Proceedings of the American Society of Clinical Oncol. 2003. Abstract #1039.
4.Wolff RA, Ayers GD, Crane CH, et al.: Serum CA19-9 levels in patients receiving preoperative gemcitabine (GEM)-based chemoradiation for resectable pancreatic adenocarcinoma. Proceedings of the American Society of Clinical Oncology. 2003. Abstract #1071.