Please use this identifier to cite or link to this item:
Title: Threshold Change in CEA as a Predictor of Non-Progression to First-Line Systemic Therapy in Metastatic Colorectal Cancer Patients with Elevated CEA.
Austin Authors: Gulhati, Pat;Yin, Jun;Pederson, Levi;Schmoll, Hans-Joachim;Hoff, Paulo;Douillard, Jean-Yves;Hecht, J Randolph;Tournigand, Christophe;Tebbutt, Niall C ;Chibaudel, Benoist;De Gramont, Aimery;Shi, Qian;Overman, Michael James
Affiliation: Department of Medical Oncology, Austin Health, Heidelberg, Victoria, Australia
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
David Gergen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
Department of Medical Oncology, Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey, USA
Integrated Centres for Oncology, Department of Medical Oncology, St-Herblain, France
Hospital Henri Mondor, Paris, France
Franco-British Institute, Levallois-Peret, France
Hospital Saint-Antoine, Paris, France
Klinik fur Innere Med IV, University Clinic Halle, Halle, Germany
Centro de Oncologia de Brasilia do Sirio Libanes-Unidade Lago Sul, Sao Paulo, Brazil
Issue Date: 19-Mar-2020 2020-03-19
Publication information: Journal of the National Cancer Institute 2020; online first: 19 March
Abstract: Carcinoembryonic antigen (CEA) levels are used in conjunction with imaging to monitor response to systemic therapy in metastatic colorectal cancer (mCRC). We sought to identify a threshold for CEA change from baseline to predict progressive disease (PD) in mCRC patients receiving first-line therapy. Patients from trials collected in the ARCAD database were included if baseline CEA was ≥10ng/mL and repeat CEA was available within 14 days of first restaging scan. Optimal cutoffs for CEA change were identified by ROC analysis. Prediction performance of cutoffs was evaluated by sensitivity, specificity, and negative predictive value (NPV). Analyses were conducted by treatment class: chemotherapy alone (chemo), chemotherapy with anti-VEGF antibody (anti-VEGF), and chemotherapy with anti-EGFR antibody (anti-EGFR). 2643 mCRC patients treated with systemic therapy were included. Median percent change of CEA from baseline to first restaging for patients with CR/PR/SD (non-PD) and PD was -53.1% and +23.6% for chemo (n=957), and -71.7% and -45.3% for anti-VEGF (n=1355). The optimal AUC cutoff for differentiating PD from non-PD on first restaging was -7.5% for chemo and -62.0% for anti-VEGF, chemo, ORadj=6.51 (95%CI 3.31-12.83, P < 0.001); anti-VEGF, ORadj=3.45 (95%CI 1.93-6.18, P < 0.001). A 99% NPV clinical cutoff for prediction of non-PD would avoid CT scan at first restaging in 21.0% of chemo and 16.2% of anti-VEGF treated patients. Among patients with SD on first restaging, those with CEA decrease from baseline had statistically significantly improved progression-free and overall survival. Change in CEA from baseline to first restaging can accurately predict non-progression and correlates with long-term outcomes in patients receiving systemic chemotherapy.
DOI: 10.1093/jnci/djaa020
PubMed URL: 32191317
Type: Journal Article
Subjects: ARCAD
Colorectal cancer
colon cancer
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Dec 7, 2022

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.