Abstract
Chemotherapy with gemcitabine has been shown to be an effective regimen in advanced or metastatic pancreatic cancer with improvement of both quality of life and survival time. The response of the tumour marker CA 19–9 to chemotherapy with gemcitabine was studied in order to find out whether it is related to survival time of patients. Forty-three consecutive patients (median age 61 years, range 39–76 years; 20 males, 23 females) suffering from histologically proven locally advanced or metastatic pancreatic adenocarcinoma and a baseline Karnofsky-index ≥ 60 were treated with gemcitabine in a dose of 1000 mg m−2weekly × 7 followed by 1 week of rest during the first cycle and thereafter 1000 mg m−2weekly × 3 followed by 1 week of rest until progression. In 36 of 43 patients serial measurements of CA 19–9 could be performed. Patients with a decrease of > 20% of the baseline CA 19–9 level after 8 weeks of treatment (n = 25) had a significantly better median survival than patients with a rise or a decrease ≤ 20% (n = 11) (268 vs 110 days;P< 0.001). The response of CA 19–9 was the strongest independent predictor of survival (P< 0.001) in the multivariate analysis. In conclusion, a decrease of CA 19–9 > 20% during the first weeks of chemotherapy with gemcitabine is associated with a better survival of patients with locally advanced or metastatic pancreatic cancer. Serial measurements of CA 19–9 are useful to decide whether further chemotherapy after the first weeks of treatment is indicated. © 2000 Cancer Research Campaign
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References
Aapro MS, Martin C and Hatty S (1998) Gemcitabine: a safety review. Anticancer Drugs 9: 191–201
Ahlgren JD (1996) Chemotherapy for pancreatic carcinoma. Cancer 78: 654–663
Burris HA, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, Cripps MC, Portenoy RK, Storniolo AM, Tarassoff P, Nelson R, Dorr FA, Stephens CD and Von Hoff DD (1997) Improvements in survival and clinical benefit with gemcitabine as first line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15: 2403–2413
Carmichael J, Fink U, Russel RCG, Spittle MF, Harris AL, Spiessi G and Blatter J (1996) Phase II study of gemcitabine in patients with advanced pancreatic cancer. Br J Cancer 73: 101–105
Cox DR (1972) Regression models and life tables. J R Stat Soc [B] 34: 187–202
Glenn J, Steinberg WM, Kurtzman SH, Steinberg SM and Sindelar WF (1988) Evaluation of the utility of a radioimmunoassay for serum CA 19–9 levels in patients before and after treatment of carcinoma of the pancreas. J Clin Oncol 6: 462–468
Gogas H, Lofts FJ, Evans TRJ, Daryanani S and Mansi JL (1998) Are serial measurements of CA 19–9 useful in predicting response to chemotherapy in patients with inoperable adenocarcinoma of the pancreas? Br J Cancer 77: 325–328
Ishii H, Okada S, Nose H, Yoshimori M, Aoki K and Okusaka T (1996) Prognostic factors in patients with advanced pancreatic cancer treated with systemic chemotherapy. Pancreas 12: 267–271
Kaplan EL and Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481
Katz A, Hanlon A, Lanciano R, Hoffman J and Coia L (1998) Prognostic value of CA 19–9 levels in patients with carcinoma of the pancreas treated with radiotherapy. Int J Radiat Oncol Biol Phys 41: 393–396
Koprowski H, Steplewski Z, Mitchell K, Herlyn M, Herlyn D and Fulner P (1979) Colorectal carcinoma antigens detected by hybridoma antibodies. Somatic Cell Genet 5: 957–971
Lundin J, Roberts PJ, Kuusela P and Haglund C (1994) The prognostic value of preoperative serum levels of CA 19–9 and CEA in patients with pancreatic cancer. Br J Cancer 69: 515–519
Okusaka T, Okada S, Sato T, Wakasugi H, Saisho H, Furuse J, Ishikawa O, Matsuno S and Yokoyama S (1998) Tumor markers in evaluating the response to radiotherapy in unresectable pancreatic cancer. Hepatogastroenterology 45: 867–872
Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A and Podolsky DK (1989) Evaluation of a serologic marker, CA 19–9, in the diagnosis of pancreatic cancer. Ann Intern Med 110: 704–709
Rollhauser C and Steinberg W (1998) Tumor antigens in pancreatic cancer. Pancreatic Cancer, Reber HA (ed) pp 137–156, Humana Press: Totowa, New Jersey
Rothenberg ML, Moore MJ, Cripps MC, Andersen JS, Portenoy RK, Burris HA, Green MR, Tarassoff PG, Brown TD, Casper ES, Storniolo AM and Von Hoff DD (1996a) A phase II trial of gemcitabine in patients with 5-FU-refractory pancreas cancer. Ann Oncol 7: 347–353
Rothenberg ML, Abbruzzese JL, Moore M, Portenoy RK, Robertson JM and Wanebo HJ (1996b) A rationale for expanding the endpoints for clinical trials in advanced pancreatic carcinoma. Cancer 78: 627–632
Safi F, Schlosser W, Falkenreck S and Beger HG (1998) Prognostic value of CA 19–9 serum course in pancreatic cancer. Hepatogastroenterology 45: 253–259
Schnall SF and Macdonald JS (1996) Chemotherapy of adenocarcinoma of the pancreas. Semin Oncol 23: 220–228
Tian F, Appert HE, Myles J and Howard JM (1992) Prognostic value of serum CA 19–9 levels in pancreatic adenocarcinoma. Ann Surg 215: 350–355
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Halm, U., Schumann, T., Schiefke, I. et al. Decrease of CA 19–9 during chemotherapy with gemcitabine predicts survival time in patients with advanced pancreatic cancer. Br J Cancer 82, 1013–1016 (2000). https://doi.org/10.1054/bjoc.1999.1035
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DOI: https://doi.org/10.1054/bjoc.1999.1035
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