CEA Flares During Chemo Don't Mean Cancer Progression

Colorectal cancer patients whose CEA blood tests rise at the beginning of chemotherapy and then fall (CEA flare) do better than patients with a consistently rising CEA.   CEA flares don’t necessarily predict worsening cancer.

Compared to patients with consistently rising carcinoembryonic antigen (CEA), patients who had a CEA flare had more tumor shrinkage, longer time before their cancer got worse, and longer survival time.

Researchers measured CEA before chemotherapy started and at least twice during chemo in patients with advanced colorectal cancer who were receiving their first course of chemotherapy.

They grouped patients according to how the CEA measurements changed over time:

  • flare
  • decreasing CEA
  • normal baseline CEA
  • stable CEA
  • increasing CEA

Comparing patients with increasing CEA measurements to patients whose CEA rose and then fell (flared):

  • Overall response rate was 11 percent in increasing CEAs compared to 73 percent in flares.
  • Progression-free survival time was 3.1 months compared to 8.3 months with flares.
  • Overall survival was 10.9 months compared to 17.7 months when CEA flared.

A. S. Strimpakos and colleagues at the Royal Marsden Hospital in London concluded,

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

More information on the CEA flare during first-line chemotherapy  is available from Dr. Strimpakos’ poster presented at the 2009 GI Symposium.

SOURCE: Strimpakos et al., Annals of Oncology, Advance Access, October 27, 2009.


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  2. Jennifer says

    I think this summary should also emphasize that patients who exhibit CEA “flares” during chemo look good ONLY compared to those whose CEA rises steadily.

    Their outcomes are still significantly worse than the other categories, i.e. those whose CEA decreases steadily throughout chemo, stays within normal range throughout chemo, or stays stable at an elevated level throughout chemo.

    Just as importantly, the fact that CEA flares are an index for initial response to chemo is no cause for great optimism. The authors conclude that “the high response associated with F (CEA flares) does not appear to correlate with a survival benefit and may even be associated with a poorer outcome.”

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