Early kinetics of CA19-9 and CEA after 5-FU-based chemotherapy for gastrointestinal cancers.

Authors

Sebastian Lange, Patrick Wenzel, Christof Winter, Jürgen Ruland, Roland M Schmid, Hana Algül, Michael Quante, Mathias Friedrich

Published in

Discover oncology. Volume 17. Issue 1. Jul 15, 2026. Epub Jul 15, 2026.

Abstract

In gastrointestinal oncology, serum tumor markers such as CEA and CA19-9 are typically monitored over several weeks to assess therapeutic efficacy. The immediate impact of cytotoxic therapy on these serum tumor markers, however, remains poorly characterized.
We analyzed a single-center cohort of patients with advanced gastrointestinal cancers (pancreatic, biliary, colorectal, and esophageal) treated with 5-fluorouracil-based regimens. Paired serum samples were collected immediately before the start of chemotherapy (0 h) and at the removal of the 48-h 5-FU continuous pump (48 h). The primary endpoint was the percentage change of tumor markers during this time window (∆CEA and ∆CA19-9). Secondary endpoints included the association of these acute kinetics with subsequent radiographic response.
78 cycles of 5-FU-based chemotherapy were included (33 patients, median cycles per patient: 2). CA19-9 increased significantly after chemotherapy (median ∆CA19-9 + 4.8% per patient, Wilcoxon p = 0.015; mixed model p = 0.062; cycle-level range - 11% to + 92%), as did LDH (median ∆LDH + 12.8% per patient, both Wilcoxon and mixed model p < 0.001; cycle-level range - 39% to + 72%). CEA levels remained stable (median ∆CEA - 3.6% per patient, Wilcoxon p = 0.09; mixed model p = 0.05; cycle-level range - 20% to + 22%). There was no statistically significant association between early changes in serum tumor markers and radiographic outcome.
In this hypothesis-generating study, 5-FU-based therapy leads to a statistically significant increase in CA19-9 and LDH levels, but not in CEA, after 48 h. The magnitude of the increase did not predict radiographic response.

PMID:
42455430
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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