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Annals of Oncology Advance Access published online on October 27, 2009
Annals of Oncology, doi:10.1093/annonc/mdp449
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

The impact of carcinoembryonic antigen flare in patients with advanced colorectal cancer receiving first-line chemotherapy

A. S. Strimpakos1, D. Cunningham1,*, C. Mikropoulos1, I. Petkar1, Y. Barbachano2 and I. Chau1

1 Department of Medicine, Royal Marsden Hospital, London and Surrey, UK
2 Department of Clinical Research & Development, Royal Marsden Hospital, London and Surrey, UK

* Correspondence to: Professor D. Cunningham, Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK. Tel: +44-208-661-3156; Fax: +44-208-643-9414; E-mail: david.cunningham{at}rmh.nhs.uk

Background: Carcinoembryonic antigen (CEA) flare may have a favourable response to chemotherapy, but its impact on survival is unknown. This study aimed to evaluate the incidence of CEA flare and its impact on objective response rate (ORR), progression-free survival (PFS) and overall survival (OS).

Patients and methods: Patients with histologically proven advanced colorectal cancer undergoing first-line chemotherapy with three or more serial CEA measurements (one at baseline and two or more during treatment) were included. Patients were grouped according to CEA kinetic as flare (F), decreasing CEA, normal baseline CEA, stable CEA and increasing CEA (I).

Results: From January 2000 to February 2008, 837 patients were screened of whom 670 were eligible. CEA flare occurred in 78 (11.6%) patients. On multivariate analysis, compared with patients with increasing CEA, patients with CEA flare had a significantly better ORR [I versus F: 11% versus 73%; risk ratio (RR): 27.96; 95% confidence interval (CI): 9.55–81.88; P < 0.001], PFS (median 3.1 versus 8.3 months; RR: 0.38; 95% CI: 0.26–0.56; P < 0.001) and OS (median 10.9 versus 17.7 months; RR: 0.53; 95% CI: 0.34–0.82; P < 0.001).

Conclusions: Compared with patients with rising CEA, flare was an independent favourable predictive and prognostic factor for tumour response and survival.

carcinoembryonic antigen, chemotherapy, colorectal cancer

Received for publication May 28, 2009. Revision received July 30, 2009. Accepted for publication August 4, 2009.


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