Serial CEA measurements for patients on adjuvant chemotherapy for colon cancer; patterns and relationship with overall survival. — ASN Events
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Serial CEA measurements for patients on adjuvant chemotherapy for colon cancer; patterns and relationship with overall survival. (#13)

Nicola Mitchell 1 , Melissa Murray 2 , Jerome Macapagal 2 , Victoria Hinder 2 , Michael Findlay 2
  1. Auckland City Hospital, Auckland, New Zealand
  2. Cancer Trials New Zealand, Discipline of Oncology, The University of Auckland, Auckland, New Zealand

Colon cancer is a common malignancy in New Zealand and Australia1,2. Serum Carcinoembryonic Antigen (CEA) measurements are used to monitor response to treatment in metastatic disease or to indicate disease relapse during follow-up in the adjuvant setting3,4. Surges of CEA levels can occur following initiation of chemotherapy in the metastatic setting and do not appear to be associated with worse outcome5,6. However, there is little data about CEA surge in the adjuvant setting. We aimed to review patterns in CEA levels before, during and after adjuvant chemotherapy, and to investigate associations between transient changes in CEA levels and survival.

A retrospective audit was performed on all patients in the Auckland region with a new diagnosis of colon cancer in 2001 or 20057. From this cohort, patients with stage II or III disease that had received at least one dose of adjuvant chemotherapy in the public sector were identified, and additional information was obtained from their medical records including; type of chemotherapy received, serum CEA measurements before, during and 6 months following chemotherapy, and tumour and patient characteristics. Death information was provided by the New Zealand Ministry of Health.

Seventy-seven patients were identified. We will describe initial CEA levels immediately before chemotherapy and patterns of change in CEA during and after chemotherapy. The relationships between CEA pattern and demographic characteristics and other prognostic factors such as disease stage, grade and smoking status will be examined. Three groups of patients will be defined; (i) those who experience a transient increase in CEA levels (a CEA surge); (ii) those who experience an increase in CEA which remains elevated and (iii) those who do not experience an increase. An exploratory analysis of CEA surge as a prognostic factor will be carried out using Kaplan-Meier survival curves and Cox regression.

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  5. An, X., et al., Carcinoembryonic antigen surge in metastatic colorectal cancer patients responding to irinotecan combination chemotherapy. Biomarkers. 2010; 15(3): p. 243-8.
  6. Li, Y.H., et al., [Clinical significance of a transient increase in carcinoembryonic antigen and carbohydrate antigen 19-9 in patients with metastatic colorectal cancer receiving chemotherapy]. Ai Zheng, 2009. 28(9): p. 939-44.
  7. Murray, M., et al., The colorectal cancer patients' journey: the Auckland region. N Z Med J. 2011; 124(1331): p. 18-28.