Decrease of CA 19-9 during chemotherapy with gemcitabine predicts survivaltime in patients with advanced pancreatic cancer

Chemotherapy with gemcitabine has been shown to be an effective regimen in advanced or metastatic pancreatic cancer with improvement of both quality o f life and survival time. The response of the tumour marker CA 19-9 to chem otherapy with gemcitabine was studied in order to find out whether it is re lated to survival time of patients. Forty-three consecutive patients (media n age 61 years, range 39-76 years; 20 males, 23 females) suffering from his tologically proven locally advanced or metastatic pancreatic adenocarcinoma and a baseline Karnofsky-index greater than or equal to 60 were treated wi th gemcitabine in a dose of 1000 mg m(-2) weekly x 7 followed by 1 week of rest during the first cycle and thereafter 1000 mg m(-2) weekly x 3 followe d by 1 week of rest until progression, in 36 of 43 patients serial measurem ents of CA 19-9 could be performed. Patients with a decrease of > 20% of th e baseline CA 19-9 level after 8 weeks of treatment (n = 25) had a signific antly better median survival than patients with a rise or a decrease less t han or equal to 20% (n = 11) (268 vs 110 days; P < 0.001). The response of CA 19-9 was the strongest independent predictor of survival (P < 0.001) in the multivariate analysis. In conclusion, a decrease of CA 19-9 > 20% durin g the first weeks of chemotherapy with gemcitabine is associated with a bet ter survival of patients with locally advanced or metastatic pancreatic can cer. Serial measurements of CA 19-9 are useful to decide whether further ch emotherapy after the first weeks of treatment is indicated. (C) 2000 Cancer Research Campaign.