Yonsei Med J.  2013 Jan;54(1):116-122. 10.3349/ymj.2013.54.1.116.

Usefulness of Carcinoembryonic Antigen for Monitoring Tumor Progression during Palliative Chemotherapy in Metastatic Colorectal Cancer

• Kim G
• Jung EJ
• Ryu CG
• Hwang DY

• KMID: 1776926
• DOI: http://doi.org/10.3349/ymj.2013.54.1.116

Abstract

PURPOSE
To evaluate the efficacy of carcinoembryonic antigen (CEA) measurement for monitoring tumor progression during palliative chemotherapy in metastatic colorectal cancer.
MATERIALS AND METHODS
Forty-eight patients with initially unresectable metastatic colorectal cancer (n=26, 54.2%) or recurrent unresectable metastatic colorectal cancer (n=22, 45.8%) received FOLFOX-4 chemotherapy for palliation. Serum CEA levels and carbohydrate antigen 19-9 levels were measured and computed tomography (CT) studies were performed prior to chemotherapy and after 3 cycles of chemotherapy. From the CT images, tumor responses were evaluated according to the Response Evaluation Criteria in Solid Tumors criteria and categorized as complete response, partial response, stable disease, and progressive disease. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of tumor marker assessments for determining tumor response were calculated.
RESULTS
The sensitivity, specificity and diagnostic accuracy of CEA assessment for prediction of disease progression were 50%, 77% and 69%, respectively. When the patients were dichotomized according to baseline CEA level, the initially elevated CEA group showed higher sensitivity and higher diagnostic accuracy compared to the initially normal CEA group (sensitivity=67% vs. 20%; diagnostic accuracy=71% vs. 62%).
CONCLUSION
CEA assessment could be useful for monitoring tumor progression during palliative chemotherapy in only patients with initially elevated CEA level.

Keyword

Carcinoembryonic antigen; disease progression; palliative treatment; chemotherapy; metastatic; colorectal cancer

MeSH Terms

Adult
Aged
Antineoplastic Agents/*therapeutic use
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
CA-19-9 Antigen/metabolism
Carcinoembryonic Antigen/*blood
Colorectal Neoplasms/drug therapy/*metabolism
Disease Progression
Female
Fluorouracil/therapeutic use
Humans
Leucovorin/therapeutic use
Male
Middle Aged
Organoplatinum Compounds/therapeutic use
Palliative Care
Predictive Value of Tests
Recurrence
Reproducibility of Results
Sensitivity and Specificity
Tomography, X-Ray Computed
Tumor Markers, Biological/blood
Antineoplastic Agents
CA-19-9 Antigen
Carcinoembryonic Antigen
Organoplatinum Compounds
Tumor Markers, Biological
Leucovorin
Fluorouracil

Reference

1. Meyerhardt JA, Mayer RJ. Systemic therapy for colorectal cancer. N Engl J Med. 2005. 352:476–487.

2. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009. 45:228–247.

3. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000. 18:2938–2947.

4. André T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004. 350:2343–2351.

5. Kalofonos HP, Aravantinos G, Kosmidis P, Papakostas P, Economopoulos T, Dimopoulos M, et al. Irinotecan or oxaliplatin combined with leucovorin and 5-fluorouracil as first-line treatment in advanced colorectal cancer: a multicenter, randomized, phase II study. Ann Oncol. 2005. 16:869–877.

6. Maughan TS, James RD, Kerr DJ, Ledermann JA, Seymour MT, Topham C, et al. Comparison of intermittent and continuous palliative chemotherapy for advanced colorectal cancer: a multicentre randomised trial. Lancet. 2003. 361:457–464.

7. Douillard JY, Cunningham D, Roth AD, Navarro M, James RD, Karasek P, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000. 355:1041–1047.

8. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer. 1981. 47:207–214.

9. Wang WS, Lin JK, Lin TC, Chiou TJ, Liu JH, Fan FS, et al. Carcinoembryonic antigen in monitoring of response to systemic chemotherapy in patients with metastatic colorectal cancer. Int J Colorectal Dis. 2001. 16:96–101.

10. Ward U, Primrose JN, Finan PJ, Perren TJ, Selby P, Purves DA, et al. The use of tumour markers CEA, CA-195 and CA-242 in evaluating the response to chemotherapy in patients with advanced colorectal cancer. Br J Cancer. 1993. 67:1132–1135.

11. Trillet-Lenoir V, Chapuis F, Touzet S, Barbier JY, Freyer G, Gaudin JL, et al. Any clinical benefit from the use of oncofoetal markers in the management of chemotherapy for patients with metastatic colorectal carcinomas? Clin Oncol (R Coll Radiol). 2004. 16:196–203.

12. Hanke B, Riedel C, Lampert S, Happich K, Martus P, Parsch H, et al. CEA and CA 19-9 measurement as a monitoring parameter in metastatic colorectal cancer (CRC) under palliative first-line chemotherapy with weekly 24-hour infusion of high-dose 5-fluorouracil (5-FU) and folinic acid (FA). Ann Oncol. 2001. 12:221–226.

13. Herrera MA, Chu TM, Holyoke ED, Mittelman A. CEA monitoring of palliative treatment for colorectal carcinoma. Ann Surg. 1977. 185:23–30.

14. Allen-Mersh TG, Kemeny N, Niedzwiecki D, Shurgot B, Daly JM. Significance of a fall in serum CEA concentration in patients treated with cytotoxic chemotherapy for disseminated colorectal cancer. Gut. 1987. 28:1625–1629.

15. Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006. 24:5313–5327.

16. Goldstein MJ, Mitchell EP. Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer. Cancer Invest. 2005. 23:338–351.

17. Duffy MJ. Carcinoembryonic antigen as a marker for colorectal cancer: is it clinically useful? Clin Chem. 2001. 47:624–630.