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Sub-category:
Multidisciplinary Treatment
Category:
Colon and Rectum
Meeting:
2009 Gastrointestinal Cancers Symposium
Session Type and Session Title:
General Poster Session F
Abstract No:
457
Author(s):
A. S. Strimpakos, I. Petkar, C. Mikropoulos, Y. Barbachano, D. Cunningham
Abstract:
Introduction: CEA flare (F) has been observed as an early biochemical phenomenon in mCRC treatment with FOLFOX chemotherapy (CT). Persistent CEA rises suggest disease progression (PD) and justify restaging. Here, we have retrospectively investigated the incidence and prognostic value of CEA F in patients (pts) receiving first line CT for mCRC. Methods: We reviewed medical notes of pts treated with any CT regimen at the Royal Marsden Hospital from January 2000 to February 2008. CEA F was defined as a >15% rise from baseline (a minimum 4 µg/L rise was accepted) followed by subsequent >15% decrease from baseline. Reference range for CEA; <3 µg/L in non-smokers, <5 µg/L in smokers. Results: 837 pts were screened. 670 were eligible for evaluation. Patients were grouped according to CEA behavior as flare (FG) [78 pts, 11.6%], decreasing CEA (DG) [318 pts, 47%], normal baseline CEA (NBG, non-secretors) [157 pt, 23%], stable CEA (SG) [34 pts, 5%] and increasing CEA (IG) [83 pts, 11%]. In the FG, median baseline CEA was at 74 µg/L [531, 480]; peak CEA was 115 µg/L [9-38, 230], reached at a median of 21 days [4-61]; trough CEA levels were seen after a median of 106 d [35-378]. F was more common with doublet CT (fluoropyrimidine + oxaliplatin/irinotecan/mitomycin C) (74/78 pts). The overall response rate (CR+PR) was 55% (371/670 pts). RR was 75%, 62%, 57%, 47% and 11% in the F, D, NB, S and I groups respectively. Disease stability was seen in 19%, 30%, 35% 20% and 26% in F, D, NB, S and I groups. PD for the same groups, in that order, was 5%, 8%, 7%, 32% and 61%. Median overall survival was 23 months. Median survival of FG pts was 16.8 months (m) versus 26.4 mo in DG pts, 36 mo in NBG, 22.8 mo in SG and 10 mo in IG pts. Conclusions: Early CEA rises do not always indicate PD, may be temporary and may even indicate a favorable, early response. However, the high response associated with F does not appear to correlate with a survival benefit and may even be associated with a poorer outcome.
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 Associated Presentation(s):
Other Abstracts in this Sub-Category:
Abstracts by A. S. Strimpakos:
Presentations by A. S. Strimpakos:
Educational Book Manuscripts by A. S. Strimpakos:
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