Prognostic and Predictive Value of Carcinoembryonic Antigen and Cytokeratin-19 Fragments Levels in Advanced Non-Small Cell Lung Cancer Patients Treated with Gefitinib or Erlotinib

• Published in: Yonsei medical journal Vol. 53; no. 5; pp. 931 - 939
• Main Authors: Jung, Minkyu, Kim, Se Hyun, Hong, Soojung, Kang, Young Ae, Kim, Se Kyu, Chang, Joon, Rha, Sun Young, Kim, Joo Hang, Kim, Dae Joon, Cho, Byoung Chul
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.09.2012; 연세대학교의과대학
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Carcinoembryonic Antigen - blood; Carcinoma, Non-Small-Cell Lung - blood; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Squamous Cell - blood; Carcinoma, Squamous Cell - drug therapy; Erlotinib Hydrochloride; Female; Humans; Keratin-19 - blood; Male; Middle Aged; Mutation; Original; Quinazolines - therapeutic use; Receptor, Epidermal Growth Factor - genetics; Retrospective Studies; Sex Factors; 의학일반
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2012.53.5.931

The prognostic and predictive value of pretreatment serum levels of carcinoembryonic antigen (CEA) and cytokeratin-19 fragments (CYFRA 21-1) were assessed in advanced non-small cell lung cancer (NSCLC) patients treated with gefitinib or erlotinib. Pretreatment CEA and CYFRA 21-1 were measured in 123 advanced NSCLC patients receiving gefitinib or erlotinib. High CEA levels (h-CEA) were significantly associated with females, patients with adenocarcinoma, and non-smokers. Low CYFRA 21-1 levels (l-CYFRA) were significantly associated with a good performance status (ECOG PS 0-1). The overall response rate (RR) was 27.6%, and higher RR was associated with adenocarcinoma, h-CEA, and epidermal growth factor receptor (EGFR) mutation. Patients with h-CEA had significantly longer progression-free survival (PFS) (p=0.021). Patients with l-CYFRA had significantly longer PFS and overall survival (p=0.006 and p<0.001, respectively). Of note, h-CEA and l-CYFRA had good prognosis in patients with unknown EGFR mutation status or patients with squamous cell carcinoma (p=0.021 and p=0.015, respectively). A good ECOG PS (HR=0.45, p=0.017), h-CEA (HR=0.41, p=0.007), l-CYFRA 21-1 (HR=0.52, p=0.025), and an EGFR mutation (HR=0.22, p<0.001) were independently predictive of a longer PFS. h-CEA and l-CYFRA 21-1 may be prognostic and predictive serum markers for higher response and longer survival in patients with advanced NSCLC receiving gefitinib or erlotinib, especially in patients with unknown EGFR mutation status or patients with squamous cell carcinoma.