Journal List > J Lung Cancer > v.9(2) > 1050727

Park, Kim, Nam, Jeong, Oak, Jang, and Jung: Serum Carcinoembryonic Antigen as an Index of the Therapeutic Effect of EGFR-TKIs in Patients with Advanced Non-Small Cell Lung Cancer

Abstract

Purpose

For treating advanced non-small cell lung cancer (NSCLC), epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are known to be very effective in nonsmokers, women, Asian and person with EGFR mutations. The efficacy of EGFR-TKI was analyzed based on the radiologic studies and the serum levels of carcinoembryonic antigen (CEA) to evaluate whether serum CEA can be used as a predicative marker of the response to EGFR-TKI therapy.

Materials and Methods

Forty-one patients with NSCLC treated with gefitinib at Kosin Medical Center from January 2007 to August 2009 were the subjects of this study. We assayed the serum CEA levels before and after gefitinib therapy with concomitant assessments of the tumor response by serial chest X-ray and chest computer tomograms (CT).

Results

The median age of the patients was 62.6 years (range, 32∼77 years), 29 patients were women, 36 had adenocarcinoma (87.8%) and the baseline serum CEA was equal or above 5 ng/mL in 31 patients (75.6%). These 31 patients were more responsive to the gefitinib therapy (p=0.021). The overall response rate of the patients was 51.2%, the median survival time was 21.9 months and the time to progression was 8.3 months. Among the 21 responding patients, the serum CEA was decreased after 2 months in 17 (80.9%), and among the 14 progressed patients, the serum CEA was increased in 12 (85.7%) (p=0.000).

Conclusion

The changes of serum CEA at 2 months after gefitinib therapy were closely related to the radiologic changes. The serum CEA could be used as a complimentary tool for monitoring the tumor response to EGFR-TKI in the advanced NSCLC patients.

References

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Figures and Tables

Fig. 1.
Survival of the patients according to the initial carcinoembryonic antigen (CEA) level (p<0.01).
jlc-9-97f1.tif
Fig. 2.
Survival of the patients according to the carcinoembryonic antigen (CEA) changes after gefitinib treatment (p <0.001).
jlc-9-97f2.tif
Fig. 3.
Overall survival of the enrolled patients.
jlc-9-97f3.tif
Fig. 4.
Changes in the carcinoembryonic antigen level according to the response to gefitinib. PR: partial response, SD: stable disease, PD: progressive disease.
jlc-9-97f4.tif
Table 1.
Clinicopathological Characteristics of the 41 Patients Treated with Gefitinib
Category No. (%)
Age, yr  
 Median (range) 62.6 (32∼77)
 <65 21 (51.2)
 ≥65 20 (48.8)
Gender  
 Male 12 (29.3)
 Female 29 (70.7)
Clinical stage  
 IIIB 8 (19.5)
 IV 33 (80.5)
Histologic type  
 Adenocacinoma 36 (87.8)
 Squamous 5 (12.2)
Serum CEA level, ng/mL  
 <5 10 (24.4)
 ≥5 31 (75.6)
EGFR mutation  
 Positive 11 (52.4)
 Negative 10 (47.6)
 Not evaluable 20
Response to gefitinib  
 Complete response 0 (0)
 Partial response 21 (51.2)
 Stable disease 6 (14.6)
 Progressive disease 14 (34.1)

CEA: carcinoembryonic antigen, EGFR: epidermal growth factor receptor.

Table 2.
Comparison of the Clinicopathological Characteristics of the Patients with a Partial Response, Stable Disease, and Progressive Disease after Gefitinib Treatment
Category PR SD PD p-value
Age, yr       0.461
 <65 9 (22.0) 3 (7.3) 9 (22.0)  
 ≥65 12 (29.3) 3 (7.3) 5 (12.2)  
Gender       0.092
 Male 3 (7.3) 3 (7.3) 6 (14.6)  
 Female 18 (43.9) 3 (7.3) 8 (19.5)  
Histologic type       0.315
 Adenocacinoma 20 (48.8) 5 (12.2) 11 (26.8)  
 Sqamous cell carcinoma 1 (2.4) 1 (2.4) 3 (7.3)  
Clinical stage       0.967
 IIIB 4 (9.8) 1 (2.4) 3 (21.4)  
 IV 17 (41.5) 5 (12.2) 11 (26.8)  
EGFR mutation       0.036
 Positive 9 (42.9) 0 (0) 2 (9.5)  
 Negative 3 (14.3) 3 (14.3) 4 (19.0)  
Serum CEA level, ng/mL       0.021
 <5 2 (4.9) 1 (2.4) 7 (17.1)  
 ≥5 19 (46.3) 5 (12.2) 7 (17.1)  
Serum CEA level       <0.001
 Increase 4 (9.8) 1 (2.4) 12 (29.3)  
 Decrease 17 (41.5) 5 (12.2) 2 (4.9)  
Total 21 (51.2) 6 (14.6) 14 (34.1) 41 (100)

Values are presented as number (%) unless otherwise indicated.

PR: partial response, SD: stable disease, PD: progressive disease, EGFR: epidermal growth factor receptor, CEA: carcinoembryonic antigen.

Table 3.
Comparison of the Initial CEA Level and the Changes after Gefitinib Treatment by the Radiologic Response
  PR+SD PD p-value
Serum CEA level, ng/mL     <0.01
 <5 3 7  
 ≥5 24 7  
Serum CEA level change     <0.001
 Increase 5 12  
 Decrease 22 2  

CEA: carcinoembryonic antigen, PR: partial response, SD: stable disease, PD: progressive disease.

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