MONITORING OF THERAPY IN INOPERABLE LUNG-CANCER PATIENTS BY MEASUREMENT OF CYFRA-21-1, TPA-M, TPS, CEA, AND NSE

In a series of 381 consecutive patients with lung tumors and benign pu lmonary diseases, we examined whether tumor markers CYFRA 21-1 (ELA, B oehringer, Mannheim), TPA-M (IRMA AB Sangtec Medical, Bromma, Sweden), TPS (IRMA, Beki Diagnostics RS, Bromma Sweden), CEA and NSE ( ELA, Ro che Basel) have the potential to contribute to clinical decision - mak ing processes with respect to diagnosis and assessment of response to therapy. The sensitivity values of the marker tests in NSCLC (CYFRA 21 -1: 44,4% >3,9 ng/ml, TPA-M: 39,4% >200 U/ml, TPS: 13,2% >230 U/ml, CE A: 37,5% >8,6 ng/ml), in SCLC (NSE: 61,9% >14.0 ng/ml) and in pleural mesothelioma (CYFRA 21 -1 and TPS: 36,4%) were found to be clearly inf erior to the yield of standard cytopathological examinations (85 - 98% ) when using the 95% specificity versus the group with benign pu2monal y disease as cut - off values. Therefore, currently available tumor ma rkets are of minor value in the primary diagnosis of lung tumors. Afte r curative surgery (Re) of NSCLC only CYFRA 21-1 levels dropped to the normal range within one week. The other markers simulated residual tu mor mass by displaying elevated marker levels after surgery. During th e monitoring of response to chemo-1 radiotherapy the changes in marker levels were compared to the clinical assessment according to standard critieria of the WHO. The criteria defined for marker response were a 65% decrease for a partial response and a 40% increase of the marker levels for progressive disease. Concordant results were obtained in 59 ,4% of the cases for CYFRA 21-1 (TPA-M: 63,3%, TPS: 65,5%, CEA: 54,8%, NSE: 68,9%). Most discordant results were obtained in tumor remission due to an insufficient decrease in the markers. Progressive disease w as most effectively indicated by CYFRA 21-1 in NSCLC 60%) and by NSE i n SCLC (70.0%). It is concluded that increasing marker levels may cont ribute to clinical decision making, at least in helping to decide whic h patients should no longer treated by ineffective and toxic drugs.