Colorectal Cancer Coverage from Every Angle

Carcinoembryonic Antigen Levels: Potential Prognostic Biomarker in Colorectal Cancer

By: Lauren Harrison, MS
Posted: Tuesday, February 19, 2019

For patients with high levels of carcinoembryonic antigen (CEA) and metastatic colon cancer, combining FOLFIRI (leucovorin, fluorouracil, irinotecan) with bevacizumab is associated with poorer overall survival. However, combining FOLFIRI and cetuximab provides a survival benefit for patients with high CEA levels and metastatic colon cancer. Julian Walter Holch, MD, of the German Cancer Consortium, and colleagues published these results from the FIRE-3 trial in the European Journal of Cancer.

Elevated baseline CEA appears to be a readily available biomarker that may predict greater benefit from first-line chemotherapy plus cetuximab as compared to bevacizumab,” concluded the authors.

The FIRE-3 trial focused on 356 patients with wild-type KRAS metastatic colorectal cancer to evaluate FOLFIRI plus cetuximab and FOLFIRI plus bevacizumab. Patients with a high CEA receiving the FOLFIRI plus bevacizumab treatment had shorter overall survival than did patients with a low CEA level receiving FOLFIRI and bevacizumab (hazard ratio = 1.5). There was no significant difference seen between patients with high and low CEA levels being treated with FOLFIRI and cetuximab (hazard ratio = 1.07, P = .74).

However, patients with a high level of CEA had better overall survival when treated with FOLFIRI/cetuximab than with FOLFIRI/bevacizumab (hazard ratio = 0.56). Patients with low CEA levels did not reap the same statistically significant benefit with FOLFIRI and cetuximab (hazard ratio = 0.78, P = .3). High CEA levels were associated with a better objective response rate to FOLFIRI/cetuximab in comparison to low CEA levels (odds ratio = 2.21).

This finding may help to optimize the sequence of anti-VEGF and anti-EGFR application in patients with RAS wild-type metastatic colorectal cancer,” the authors concluded.

Disclosure: The study authors reported no conflicts of interest.

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