The association of carbohydrate antigen 19-9 response with radiologic response and survival in intrahepatic cholangiocarcinoma: A prospective cohort study

BACKGROUND

The role of carbohydrate antigen 19-9 (CA 19-9) in response assessment among patients with intrahepatic cholangiocarcinoma (iCCA) remains unknown. The authors studied the association of the CA 19-9 response (defined as a reduction >50% from baseline) with the radiologic response and the outcome in patients with unresectable iCCA.

METHODS

A prospective cohort of 422 patients who were initially diagnosed with unresectable iCCA, had baseline CA 19-9 levels ≥100 U/mL, and received treatment with systemic therapies at the authors' institution between January 2017 and December 2021 were enrolled in this study. The radiologic response was assessed using the Response Evaluation Criteria in Solid Tumors version 1.1. A landmark assessment of the CA 19-9 response and the radiologic response was performed. The associations between CA 19-9 response and imaging response, progression-free survival (PFS), and overall survival (OS) were analyzed.

RESULTS

Two hundred sixty-seven patients (63.3%) had a CA 19-9 response. A CA 19-9 response was observed in 123 of 132 (93.2%) radiologic responders and in 144 of 290 (49.7%) radiologic nonresponders (p < .001). CA 19-9 responders outperformed nonresponders in median PFS (10.6 vs. 3.6 months; hazard ratio [HR], 4.8 months; 95% confidence interval [CI], 3.8-6.0 months; p < .001) and OS (21.4 vs. 6.3 months; HR, 5.3 months; 95% CI, 4.2-6.7 months; p < .001). The common independent predictors of both OS and PFS included metastasis, CA 19-9 nonresponder status, and radiologic nonresponder status in multivariable analysis.

CONCLUSIONS

CA 19-9 response is a valuable addition to assess tumor response and is associated with improved outcomes in patients with iCCA. Achieving a CA 19-9 response should be one of the therapeutic objectives of patients with iCCA after systemic therapies.

PLAIN LANGUAGE SUMMARY

A decline in carbohydrate antigen 19-9 levels from elevated baseline levels should be one of the therapeutic aims of patients with intrahepatic cholangiocarcinoma who are managed with systemic therapies.

Selecting surgical candidates with locally advanced pancreatic cancer: a review for modern pancreatology

Pancreatic cancer (PC) is likely to become the second leading cause of malignancy-associated mortality within the next 10 years and surgery remains the best hope for cure. The introduction of effective neoadjuvant treatment (NAT) has increased the resection rate of PC in the era of contemporary pancreatology. This review summarizes the surgical selection criteria for locally advanced PC (LAPC), by focusing on the commonly used predictors for resectability and better overall survival outcome. Based on the currently available evidence, the role of change in carbohydrate antigen 19-9 (CA 19-9) and patient's tumor response to NAT are critical in surgical candidacy selection. Although, consensus on surgical candidacy selection for LAPC still needs to be made, several data have shown that surgery provides the most optimistic chance of cure for PC. Surgery is, therefore, recommended whenever the benefits of pancreatectomy outweigh surgical complications, and the chance of local or distant metastases in the postoperative setting is low. This review also provided our insight for and experience in selecting surgical candidates by focusing on optimizing the overall survival of LAPC patients. Nevertheless, a collaborative approach to formulating standardized criteria for surgical candidate selection and treatment guidelines for LAPC is a common goal that pancreatologists worldwide should focus on.

Targeting CA 19-9 with a humanized monoclonal antibody at the time of surgery may decrease recurrence rates for patients undergoing resections for pancreatic cancer, cholangiocarcinoma and metastatic colorectal cancer

Operable gastrointestinal cancers continue to pose significant challenges. Radical resections are rarely curative, and chemotherapy is able to reduce tumor recurrence for only a small percentage of patients. Despite the obvious advantages of extirpation of the identifiable tumor(s), the inflammatory milieu that accompanies surgery and the obligate time off cytotoxic agents allows for activation of remote quiescent disseminated tumor cells, leading to metastatic recurrence. We are conducting a study to determine the safety and efficacy of immediate peri-operative MVT-5873, a cytotoxic monoclonal antibody targeting carbohydrate antigen 19-9 (CA 19-9), in patients undergoing resections pancreatic cancer, cholangiocarcinoma or metastatic colorectal cancer to the liver. Eligible patients will receive a single dose of MVT-5873 three days before resection and four post-operative infusions, before beginning standard adjuvant regimens. MVT-5873 is a human IgG1 antibody isolated from a patient following immunization with a sLe^a-KLH vaccine. MVT-5873 demonstrated cell surface binding in sLe^a positive human tumor lines and has been shown to be potent in complement-dependent cytotoxicity assays and antibody-dependent cell mediated cytotoxicity assays. In patients with metastatic CA 19-9 producing pancreatic adenocarcinoma, MVT-5873 treatment has been shown to decrease serum CA 19-9 levels and prevent tumor progression. The use of perioperative MVT-5873 has the potential to reduce recurrence rates and prolong survival after resection. This trial may open the door for investigation of additional and/or synergistic agents in the immediate peri-operative period and usher in a new paradigm in the management of surgically treated cancers.

Trial registration

https://clinicaltrials.gov/ct2/show/NCT03801915?term=MVT&rank=3.

Prognostic impact of carbohydrate antigen 19-9 level at diagnosis in resected stage I-III pancreatic adenocarcinoma: a U.S. population study

BACKGROUND

Pancreatic adenocarcinoma is a highly aggressive cancer, with surgical resection and systemic therapy offering the only hope for long-term survival. Carbohydrate antigen 19-9 (CA 19-9) has been used as a prognostic marker after resection; however, the relationship between survival and pre-treatment CA 19-9 level remains unclear. This study evaluates pre-treatment serum CA 19-9 level as a predictor for long-term survival.

METHODS

The U.S. National Cancer Data Base [2004-2012] was reviewed for patients with clinical stages I-III resected pancreatic adenocarcinoma with recorded pre-treatment CA 19-9 levels (U/mL). Kaplan Meier and Weibull survival analyses were performed.

RESULTS

Four thousand seven hundred and one patients were included: 12.6% received neoadjuvant therapy (NAT), 27.4% underwent surgery, and 60.1% underwent surgery and adjuvant therapy. Amongst those who underwent initial surgery, there was no association between CA 19-9 levels ≤800 (≤100, 101-300, 301-500, 501-800) with survival (stage I P=0.7592, stage II P=0.5088, stage III P=0.9037). Levels >800 were associated with significantly worse survival in all stages (P≤0.0001, all). Amongst those who received NAT, levels >800 were associated with worse survival in early (stage I P=0.0001), but not advanced stage disease (stage II P=0.1891, stage III P=0.9316). In multivariable analyses, levels >800 demonstrated a 3.29 greater hazard of mortality with respect to patients with levels ≤100 (P<0.0001).

CONCLUSIONS

Pre-treatment CA 19-9 levels >800 appear to be associated with advanced disease, and are negatively associated with long-term survival. However, levels ≤800 had no significant association with survival. Although this study suggests an association, further study is needed to evaluate whether patients with CA 19-9 levels >800 benefit from NAT.

μPAD Fluorescence Scattering Immunoagglutination Assay for Cancer Biomarkers from Blood and Serum

A microfluidic paper analytical device (μPAD) was created for the sensitive quantification of cancer antigens, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9), from human whole blood and serum, toward diagnosis and prognosis of colorectal cancer. Anti-CEA and anti-CA 19-9 antibodies were covalently linked to submicron, fluorescent polystyrene particles, loaded, and then dried in the center of the μPAD channel. CEA- or CA 19-9-spiked blood or serum samples were loaded to the inlet of μPAD, and subsequent immunoagglutination changed the fluorescent scatter signals upon ultraviolet (UV) excitation. The total assay time was about 1 min. Detection limits were 1 pg/mL for CEA and 0.1 U/mL for CA 19-9 from both 10% diluted blood and undiluted serum. The use of UV excitation and subsequent fluorescence scattering enabled much higher double-normalized intensities (up to 1.28-3.51, compared with 1.067 with the elastic Mie scatter detection), successful detection in the presence of blood or serum, and distinct multiplex assays with minimum cross-reaction of antibodies. The results with undiluted serum showed the larger dynamic range and smaller standard errors, which can be attributed to the presence of serum proteins, functioning as a stabilizer or a passivating protein for the particles within paper fibers.

The clinical utility of normal range carbohydrate antigen 19-9 level as a surrogate marker in evaluating response to treatment in pancreatic cancer-a report of two cases

Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker that is has been has been intensely studied and investigated as a surrogate marker in pancreatic cancer (PC). It is also commonly utilized in the clinical management of PC. We report two cases where normal range CA 19-9 level has been shown to be useful as a surrogate marker for following PC progression and response to treatment. Initially in our cases, both patients had a resectable tumor and their tumor markers were within normal range. In both cases the normal range CA 19-9 increase from the baseline was associated with corresponding progressive disease on imaging studies and CA 19-9 decline was in keeping with response to systemic and local therapy despite being within the normal range. To our knowledge, this is the first case report where we report the utility of serial normal values of CA 19-9 as a useful tool in following PC disease activity and in response to treatment. Clinicians should consider measuring serial normal values of CA 19-9 in patients with PC and normal range CA 19-9 which may help in assessing response to treatment in subset of this population.