Investigation of The Effects of FOLFOX and CAPOX Chemotherapy Protocols on CEA and CA 19-9 in Colon Cancer

Year 2023, Volume: 12 Issue: 4, 2015 - 2020, 26.12.2023

Birsen Ecem İbabay , Elif Ercan , Ahmet Çarhan

https://doi.org/10.37989/gumussagbil.1225732

Abstract

The most common markers used in the diagnosis of the colon cancer are CEA and CA 19-9. Chemotherapy is applied as an adjuvant and a neo-adjuvant treatment in colon cancer.
Our aim was to investigate the effects of FOLFOX and CAPOX on CEA and CA 19-9 levels before and after chemotherapy in different patient groups.
The CEA and CA 19-9 values before and after chemotherapy for the 60 patients diagnosed with metastatic colon cancer having FOLFOX or CAPOX therapy age over 18 whom hospitalised between 2017-2020, were used.
The mean value for CA 19-9 of T0 for FOLFOX receiving group was calculated as 263.71 ± 709.87 U/ml and was 119.57 ± 246.34 U/ml of for the 3rd month. The mean value for CEA for receiving FOLFOX was calculated as 76.11 ± 204.22 ng/g at T0, and 50.53 ± 142.50 ng/g at the 3rd month. The mean value of CEA for receiving CAPOX was calculated as 139.62 ± 388.87 ng/g at T0, and 117.05 ± 272.08 ng/g at the 3rd month. Intertemporal CEA levels of individuals receiving CAPOX were found to show significant differences (p=0.074). CA 19-9 mean of T0 was calculated as 218.43 ± 605.53 U/ml and the 3rd month mean of 174.40 ± 465.61 U/ml of the patients receiving CAPOX. It was found that the intertemporal values of the individuals in terms of CA 19-9 levels were not statistically significant (p=0.649).
In conclusion, CA 19-9 and CEA levels of the patients decreased even more in the 3rd month when treated with FOLFOX. The decrease in CEA was found to be more significant. In terms of CAPOX treatment, the interquartile range T0 and the 3rd month levels did not show a significant difference, statistically (p=0.143 and p=0.089).

Keywords

CA 19-9, CAPOX, CEA, Colon Cancer, FOLFOX

Kolon Kanseri Hastalarında FOLFOX ve CAPOX’un CEA ve CA 19-9 Üzerine Etkisinin Araştırılması

Abstract

Kolon kanseri tanısında en sık kullanılan belirteçler CEA ve CA 19-9'dur. Kolon kanserinde Kemoterapi uygulaması adjuvan ve neo-adjuvan olarak yapılmaktadır.
Çalışmadaki amacımız, FOLFOX ve CAPOX 'un farklı hasta gruplarında kemoterapi öncesi ve sonrası CEA ve CA 19-9 düzeylerine etkilerini araştırmaktı.
2017-2020 yılları arasındaki, 18 yaş üstü FOLFOX veya CAPOX kemoterapi protokolü alan, metastatik kolon kanseri tanısı almış 60 hastanın kemoterapi öncesi (T0) ve 3. aydaki CEA ve CA 19-9 değerleri kullanılmıştır.
FOLFOX tedavisi alan hastaların ortalama CA 19-9 değerleri T0'da 263,71 ± 709,87 U/mL ve 3.ayda 119,57 ± 246,34 U/mL, CEA değerleri T0'da 76,11 ± 204,22 ng/gr ve 3.ayda 50,53 ± 142,50 ng/gr olarak hesaplanmıştır. CAPOX alan grupta ortalama CEA değeri T0'da 139,62 ± 388,87 ng/gr ve 3.ayda 117,05 ± 272,08 ng/gr olarak hesaplanmıştır. CAPOX alan bireylerde başlangıç ve 3.ayda CEA düzeylerindeki farklılıklar anlamlı bulunmuştur (p=0,074). CAPOX alan hastaların CA 19-9 ortalaması T0’da 218,43 ± 605,53 U/mL ve 3.ayda 174,40 ± 465,61 U/mL olarak hesaplanmıştır. Bireylerin başlangıç ve 3.ay CA 19-9 değerleri istatistiksel olarak anlamlı bulunmamıştır (p=0,649).
Sonuç olarak, FOLFOX ile tedavi edilen hastaların CA 19-9 ve CEA seviyelerinin 3. ayda daha da düştüğü bulunmuş ve CEA seviyelerindeki azalma daha anlamlı bulunmuştur. CAPOX tedavisi alanlarda, çeyrekler arası başlangıç ve 3. ay seviyeleri istatistiksel olarak anlamlı bulunmamıştır (p=0,143 ve p=0,089).

Keywords

CA 19-9, CAPOX, CEA, FOLFOX, Kolon Kanseri

References

• 1. Hassan, C, Zullo, A, Laghi, A. (2007). ‘‘Colon cancer prevention in Italy: cost-effectiveness analysis with CT colonography and endoscopy’’. Dig Liver Dis, 39,242-50.
• 2. Benson, A, Venook, A. (2018). ‘‘NCCN Guidelines Insights: Colon Cancer’’, 16, 4.
• 3. Cancer.Net Editorial Board. (2017). ‘‘Colorectal Cancer’’ https://www.cancer.net/cancer-types/colorectal-cancer/stages. Access date: 10/2019.
• 4. Cappell, M.S. (2005). ‘‘The pathophysiology, clinical presentation, and diagnosis of colon cancer and adenomatous polyps.’’ Clin North Am,89,1-42.
• 5. Speights, V.O, Johnson, M,W, Stoltenberg, P,H., et al. (1991). ‘‘Colorectal cancer: current trends in initial clinical manifestations.’’ South Med J 84,575-8.
• 6. Steinberg, S.M, Barkin, J.S, Kaplan, R.S, et al. (1986). ‘‘Prognostic indicators of colon tumors: the Gastrointestinal Tumor Study Group experience.’’ Cancer;57,1866-70.
• 7. Thomsen, M, Skovlund, E, Sorbye, H, Bolstad, H, Nustad, K.J, Glimelius, B, Pfeiffer, Kure, E.H, Johansen, J.S, Tveit, K.V, Christoffersen, T, Guren, T.K. (2018). ‘‘Prognostic role of carcinoembryonic antigen and carbohydrate antigen 19-9 in metastatic colorectal cancer: a BRAF-mutant subset with high CA 19-9 level and poor outcome.’’ British Journal of Cancer. Br J Cancer 118, 1609–1616. https://doi.org/10.1038/s41416-018-0115-9
• 8. Kim, H.J, Lee, K, Kim, Y.J, Oh, D, Kim J.H, Im, S, Lee, J.S. (2009). ‘‘Chemotherapy-induced transient CEA and CA19-9 surges in patients with metastatic or recurrent gastric cancer.’’ Acta Oncologica 48,385-390.
• 9. Jia, J, Zhang, P, Gou, M, Yang, F, Qian, N, Dai, G. (2019). ‘‘The Role of Serum CEA and CA19-9 in Efficacy Evaluations and Progression-Free Survival Predictions for Patients Treated with Cetuximab Combined with FOLFOX4 or FOLFIRI as a First-Line Treatment for Advanced Colorectal Cancer. Hindawi Disease Markers.’’ Disease Markers, vol. 2019, Article ID 6812045, 8 pages. https://doi.org/10.1155/2019/6812045
• 10. Hashimuze, R, Kawahara, H, Ogawa, M, Suwa, K., Eto, K., Yanaga, K. (2019). ‘‘CA 19-9 Concentration After First-line Chemotherapy Is Prognostic Predictor of Metastatic Colon Cancer.’’ in vivo 33,2087-2093.
• 11. Vukobrat-Bijedic, Z, Husic-Selimovic, A, Sofic, A, Bijedic, N, Bjelogrlic, I, Gogov, B, Mehmedovic, A. (2013). ‘‘Cancer Antigens (CEA and CA 19-9) as Markers of Advanced Stage of Colorectal Carcinoma.’’ Med. Arh. 67(6), 397-401.
• 12. Mizuno, H, Miyake, H, Nagai, H, Yoshioka, Y, Shibata, K, Asai, S, Takamizawa, J, Yuasa, N. (2021). ‘‘ Optimal cutoff value of preoperative CEA and CA19-9 for prognostic significance in patients with stage II/III colon cancer.’’ Langenbeck's Archives of Surgery, 406, 1987 - 1997.
• 13. Urvay, S, Karagoz, H. (2021). ‘‘Prognostic Role of Pre-Treatment Carcinoembryonic Antigen and Carbonhydrate Antigen 19-9 in Metastatic Colorectal Cancer.’’ EJMI ,5(1),73–80.
• 14. Değirmencioğlu S, Tanrıverdi O, Demiray A.G, Senol H, Doğu G.G, Yaren A. (2019). ‘‘Retrospective comparison of efficacy and safety of CAPOX and FOLFOX regimens as adjuvant treatment in patients with stage III colon cancer.’’ Journal of International Mediacal Resarch ,47(6), 2507–2515.
• 15. Souglakos J, Boukovianas I, Kakolyris S, Xynogalos S, Ziras N. ‘‘Three versus six months adjuvant FOLFOX or CAPOX for high risk stage II and stage III colon cancer patients: the efficacy results of Hellenic Oncology Research Group (HORG) participation to the International Duration Evaluation of Adjuvant chemotherapy (IDEA) Project. 2019.’’ Journal of Clinical Oncology, 37,15, 3500-3500
• 16. Loree J.M, Mulder K.E, Ghosh S, Spratlin J.L.(2014). ‘‘CAPOX Associated With Toxicities of Higher Grade but Improved Disease-Free Survival When Compared With FOLFOX in the Adjuvant Treatment of Stage III Colon Cancer.’’ Clinical colorectal cancer, 13,3, 172-7 .
• 17. Sobrero A, Lonardi S, Rosati G, Bartelomeo M, Ronzoni M, Pella N. (2018). ‘‘FOLFOX or CAPOX in Stage II to III Colon Cancer: Efficacy Results of the Italian Three or Six Colon Adjuvant Trial.’’ Journal of Clinical Oncology, 6,1478-1485.