A new Mayo Clinic (MN, USA) study indicates that just one in five pancreatic patients in the US are receiving the widely available CA 19-9 tumor marker blood test at diagnosis. This inexpensive test can assist in predictions of patient outcomes and thus help guide treatment choices.
The findings, which were presented at the annual meeting of the Western Surgical Association (held 7–10 November 2015, CA, USA), demonstrate that individuals with pancreatic cancer who have elevated levels of CA 19-9 in their blood are associated with a worse prognosis. However, if these individuals are able to undergo surgery and receive neoadjuvant chemotherapy, this personalized treatment sequence can eliminate the elevated biomarker’s negative effect.
“When we looked at how these patients did after surgical removal of their cancers, the only treatment sequence that completely eliminated the increased risk posed by CA 19-9 elevation was chemotherapy followed by surgical removal of the tumor,” commented senior author Mark Truty of Clinic in Rochester (MN, USA).
Utilizing data from the National Cancer Data Base, the team analyzed cancer outcomes in 97,000 patients with pancreatic malignancies. The study found that pancreatic cancer patients with elevated CA 19-9 levels tended to have worse outcomes than others at the same stage of cancer. Furthermore, the elevated tumor marker’s negative effect on survival was most pronounced in patients diagnosed at an early stage
“This is another argument for giving chemotherapy before surgery in all pancreatic cancer patients and ending the old practice of surgery followed by chemo,” continued Truty. “The study answers an important clinical question and applies to every pancreatic cancer patient being considered for surgery.”
This large investigation also determined that just 19% of pancreatic cancer patients in the US are undergoing analysis of CA 19-9 at diagnosis. The investigators highlight how lack of testing could mean that many patients with elevated CA 19-9 may undergo significant surgeries that may not be as beneficial as anticipated.
“Our conclusion is that every patient should have a CA 19-9 test at diagnosis. This is a simple, cheap and widely available test that allows personalization of pancreatic cancer treatment,” concluded Truty. “Further, patients with any elevation of CA 19-9 should be considered for preoperative chemotherapy to eliminate this risk.”