Early serum tumor marker levels after fourteen days of tyrosine kinase inhibitor targeted therapy predicts outcomes in patients with advanced lung adenocarcinoma

Objective

Image evaluation strategy for lung cancer patients has difficulty obtaining the appropriate quantity of diffuse lung nodules and bone metastases. The study was to demonstrate whether early variations in the levels of serum 4-tumor markers (4-TMs)(carcinoembryonic antigen [CEA], cancer antigen [CA]125, CA19-9, and CA15-3) after TKI targeted therapy were associated with treatment response in patients with lung adenocarcinoma.

Methods

Patients with stage IIIB-IV lung adenocarcinoma taking epidermal growth factor receptor (EGFR) TKIs or anaplastic lymphoma kinase (ALK) inhibitors were enrolled prospectively from June 2012 to February 2015. According to the variations of the percentage of change in 4-TM levels (4-TMpc), we divided patients into ascending (increases in 4-TMpc over the 7th- 14th day) and descending (decreases in 4-TMpc over the 7th- 14th day) groups.

Results

184 patients were enrolled, and 89% had at least one of the pre-treatment evaluable TMs and were further analyzed. An excellent response to the TKI targeted therapy was accurately predicted in the descending group, as determined using receiver operating characteristic curve analysis (an area under the curve, 0.83). Multivariate Cox hazards model analyses demonstrated that the type of 4-TMpc and mutation status were the strongest predictors of progression-free survival (PFS)(descending versus ascending, hazard ratios [HR] 0.30, 95% confidence interval [CI], 0.19–0.47; sensitive mutation versus wide type, HR 0.30, 95% CI, 0.19–0.48).

Conclusions

Type of 4-TMpc 14 days after TKI targeted therapy is associated with an image response and PFS, without regarding mutation status, in patients with advanced lung adenocarcinoma.

Serum Cathepsin H as a Potential Prognostic Marker in Patients with Colorectal Cancer

Cathepsin H is a lysosomal cysteine protease that may participate in tumor progression. In order to evaluate its potential as a prognostic marker, its protein levels were measured by ELISA in preoperative sera from 324 patients with colorectal cancer. The level of cathepsin H was significantly increased in patient sera, the median level was 8.4 ng/mL versus 2.1 ng/mL in 90 healthy blood donors (p<0.0001). A weak association of cathepsin H levels was found with patient age (p=0.02) but not with Dukes’ stage, sex, or the level of carcinoembryonic antigen (CEA). In survival analysis a significant difference was found between the group of patients with low cathepsin H (first tertile) who had a poor prognosis and the remaining patients (p=0.03). The risk of patients was further stratified when cathepsin H levels were combined with CEA. Patients with high CEA and low cathepsin H had the highest risk of death with a hazard ratio of 2.72 (95% CI 1.73–4.28), p<.0001. Our results show that the prognostic information of cathepsin H differs from that of the related cathepsins B and L and suggest different roles during the progression of malignant disease.

Elevated CA 125 and ascites: not always malignancy

BACKGROUND

We present two clinical cases from a single institution where a final diagnosis of cardiac failure was made following the initial finding of ascites and an elevated CA 125 level. In both cases gynaecological malignancy was initially suspected.

METHODS

Following negative confirmatory tests for gynaecological malignancy, echocardiography was undertaken.

RESULTS

Patient 1 had severe right ventricular dilatation and dysfunction. Patient 2 had biventricular dysfunction with pulmonary hypertension. Both patients responded to standard therapy for heart failure, including loop diuretics.

Evaluation of the role of CT in the assessment of response to selective internal radiation therapy in patients with colorectal liver metastases

Selective internal radiation therapy (SIRT) is a relatively new method for treating non-resectable liver tumours. There is reason to believe that conventional assessments of response by CT scan may underestimate the efficacy of this treatment. A study was undertaken in 54 patients to evaluate CT changes after SIRT for advanced colorectal cancer and to compare these with tumour marker (carcinoembryonic antigen (CEA)) changes to determine how best to assess whether a response has occurred. Computed tomography scans were carried out before treatment and at 3-monthly intervals thereafter. Serial CEA measurements were undertaken at 4-weekly intervals. Index lesions were identified and their size was assessed on serial scans by three independent, blinded investigators. Per cent changes in CEA levels after SIRT were calculated for all patients. Disappearance of all index lesions was noted in five patients (9.3%). A decrease in the size was seen in a further 41 patients (76%), no change was seen in five (9.3%), and an increase in size was noted in three (5.4%). The time taken for the maximum decrease in size to occur ranged from 3 to 21 months (median 12 months). Carcinoembryonic antigen changes were more dramatic, with a reduction of more than 75% within 2 months in 35 of 50 patients (70%) and a rise in only 3 of 50 patients (6%). Early assessment of response by CT scan may be misleading because of the time taken for size reduction to occur. Response to SIRT is more accurately judged in the early stages by tumour marker data.

Elevated carbohydrate antigen 125 levels in hypertrophic cardiomyopathy patients with heart failure

Carbohydrate antigen 125 (CA 125), known as a tumor marker for ovarian cancer, has been reported to increase and relate to severity in heart failure patients with systolic dysfunction. Hypertrophic cardiomyopathy (HCM) has a wide clinical spectrum that often includes heart failure symptoms. The aim of this study was to evaluate the role of CA 125 in HCM patients, its relation to severity of symptoms, and degree of diastolic dysfunction. CA 125 blood levels were determined in 32 HCM patients (21 male; age 51.3 +/- 18.4 years) and in 30 healthy volunteers (19 male; age 49.6 +/- 16.1 years). Echocardiographic examinations were performed in all patients. The results were grouped according to clinical status (New York Heart Association class) of the patients. The mean serum level of CA 125 was 14.6 +/- 23.8 U/ml in the study group and 7.6 +/- 4.8 U/ml in the control group. There was no significant difference between the groups (P = 0.12). CA 125 levels increased as the New York Heart Association functional class increased (class I/II: 6.2 +/- 2.4 U/ml; class III: 30.6 +/- 36.4 U/ml; P < 0.001). The mean CA 125 level in functional class III patients (30.6 +/- 36.4 U/ml) was significantly higher than that of the control group (7.6 +/- 4.8 U/ml) (P < 0.001) and the functional class I/II group (6.2 +/- 2.4 U/ml) (P < 0.001). There was a significant difference over all three diastolic dysfunction groups with respect to CA 125 levels (4.9 +/- 1.3 U/ml in impaired relaxation group, 11.8 +/- 6.9 U/ml in pseudonormal group, and 52.6 +/- 45.6 U/ml in restrictive filling group; P < 0.0001). Serum CA 125 is related to the clinical severity of HCM. Whether CA 125 has a specific biological role in HCM requires further investigation.

Tumour marker levels in patients with chronic heart failure

BACKGROUND

Carbohydrate Antigen 125 (CA 125), a marker for ovarian cancer has been reported to increase in relation to the severity of heart failure.

OBJECTIVE

To evaluate the serum levels of CA 125 and other tumour markers, in patients with chronic heart failure.

METHODS

Blood levels of CA 125 and other tumour markers were determined in 44 heart failure patients (16 males and 28 females; age 66.3+/-6.5 years) before and after optimal medical treatment. Levels were also evaluated in 30 healthy volunteers (11 males and 19 females; age 65.7+/-9.8 years). The results in the heart failure patients were grouped according to clinical status (New York Heart Association Class). The mean duration of follow-up was 3+/-1.5 months.

RESULTS

The mean serum level of CA 125 was 81.9+/-91 in the patient group and 7.5+/-4.8 in control group (p<0.001). The mean CA 19-9 level in the patient group (16.8+/-16.6) was significantly higher than in the control group (4.5+/-2.6) (p<0.001). CA 125 levels increased as the New York Heart Association (NYHA) functional class increased (Class I/II: 17.7+/-22.4 U/ml; Class III: 99.6+/-92.1 U/ml; Class IV 136.4+/-102.8 U/ml; p<0.05). There were no significant differences in serum CA 125 and other tumour marker levels before and after optimisation of treatment. Significantly higher serum CA 125 levels were found in patients with pericardial effusion (p=0.002) when compared to patients without pericardial effusion.

CONCLUSION

Among the tumour markers evaluated, only CA 125 seems to be specifically related to the presence and severity of heart failure and also the presence of pericardial fluid. Therefore, measurements of CA 125 serum levels might be proposed for the serial assessment of heart failure. Whether CA 125 has a specific biological role in heart failure requires further investigation.

CA 125 and its relation to cardiac function

BACKGROUND

CA 125, known as a marker for ovarian cancer with hypothetical but hitherto uncharacterized biologic functions, was reported to be elevated in some not-well-defined benign conditions. There are no reports on fluctuations of CA 125 related to cardiac function, especially the failing heart and neurohumoral factors such as norepinephrine or atrial natriuretic peptid/e.

METHODS AND RESULTS

CA 125 blood levels were determined in patients with heart failure before and after heart transplantation (HTx). In 71 patients, parallel determinations of norepinephrine, atrial natriuretic peptide, pulmonary capillary wedge pressure, and right atrial filling pressure were done. CA 125 levels also were prospectively studied in patients with heart failure with stabilization (n = 25) or worsening of the clinical status (n = 9) and after HTx (n = 25). Parallel determinations of the tumor markers CEA, CA 199, CA 153, TPS, and TPA were also done. The results were grouped according to the clinical status (New York Heart Association class) of the patients. CA 125 was significantly correlated with neurohormones and filling pressures. Follow-up investigations revealed a decrease of CA 125 levels after HTx (401 +/- 259 U/L vs 33 +/- 22 U/L, P <.001, n = 25) or stabilization (429 +/- 188 U/L vs 78 +/- 35 U/L, P <.001, n = 25) and an increase during worsening of heart failure (42 +/- 25 U/L vs 89 +/- 32 U/L, P <.01, n = 9). In 4 patients after HTx, unexpected death was preceded by rising CA 125 levels. CEA, CA 199, CA 153, TPS, or TPA did not correlate with heart failure status or clinical events.

CONCLUSIONS

CA 125 is a marker of the clinical and hemodynamic status and the course of patients with heart failure before and after heart transplantation. The determination of CA 125 serum levels may be an additional tool in the management of these patients. In patients with cancer, these "nonspecific" changes must be considered when CA 125 levels are determined. Whether CA 125 has a specific biologic role in heart failure deserves further studies.

Tumor markers. An update

Cancer remains the second leading cause of death in developed countries, and the incidence of certain tumors is increasing despite emphasis on prevention and screening. Tumor markers are biologic or biochemical substances that are produced by tumor cells and then secreted into the circulation in detectable amounts. This article covers some of the more common tumor markers currently being utilized for diagnostic and prognostic purposes.