Sustained Carbohydrate Antigen 19-9 Response to Neoadjuvant Chemotherapy in Borderline Resectable Pancreatic Cancer Predicts Progression and Survival

Abstract

ABSTRACT Background. As neoadjuvant therapy of borderline resect- able pancreatic cancer (BRPC) is becoming more widely uti- lized, better indicators of progression are needed to help guide therapeutic decisions. Methods. A retrospective review was performed on all patients with BRPC who received 24 weeks of neoadjuvant chemotherapy. Patients with chemotoxicity or medical com- orbidities limiting treatment completion and non- expressors of CA19-9 were excluded. Serum CA19-9 response was analyzed as a predictor of disease progres- sion, recurrence, and survival. Results. One hundred and four patients were included, 39 (37%) progressed on treatment (18 local and 21 distant), and 65 (63%) were resected (68% R0). Multivariate logistic regression analysis determined that the percent decrease in CA19-9 from baseline to minimum value (OR 0.947, p= <0.0001). Conclusion. Patients with initially elevated CA19-9 levels who do not have a decline to a sustained low level are at risk for progression, recurrence, and poor survival. Alterna- tive treatment strategies prior to an attempt at curative re- section should be considered in this cohort. The Oncologist 2020;9999:•• Implications