Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.
Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
Thorac Cancer. 2020 Jul;11(7):1790-1800. doi: 10.1111/1759-7714.13449. Epub 2020 May 7.
In addition to radiological evaluation, biomarkers may be useful in providing early information on the response to treatment, and supporting clinical decision-making. The objective of this study was to investigate carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) as biomarkers for early assessment of response in patients with advanced non-small cell lung cancer (NSCLC) treated with platinum-based chemotherapy.
A retrospective follow-up study was conducted from 2012 to 2017 among 593 consecutive patients with advanced NSCLC treated with first-line platinum-based chemotherapy in a large teaching hospital in the Netherlands. Pretreatment biomarker levels and changes from pretreatment levels were studied for association with radiologic response (partial response [PR] or complete response [CR], according to RECIST 1.1) using multivariate logistic regression, and with overall survival using COX proportional hazard modeling. Patient and disease characteristics such as age and disease stage were taken into account as potential confounding factors.
Decreases in CEA and LDH (≥ 20%), particularly early in treatment, were significantly associated with better radiological response. Increases in these biomarkers (≥ 20%) and high pretreatment LDH levels (≥ 247 U/L) were significantly associated with lower overall survival.
Our results support determination of CEA and LDH levels for earlier assessment of response to platinum-based chemotherapy in patients with advanced NSCLC. Hence, routine determination and evaluation of CEA and LDH levels, prior to each cycle of platinum-based chemotherapy in advanced NSCLC, should be considered as part of daily clinical practice.
SIGNIFICANT FINDINGS OF THE STUDY: Serum biomarkers in monitoring of treatment in advanced NSCLC would be useful. CEA and LDH decrease (≥ 20%) is favorable for achieving radiological response. High LDH levels and CEA/LDH increase (≥ 20%) is associated with reduced survival.
Monitoring of CEA seems to be particularly relevant in early stage of treatment. CEA and LDH determination should be considered as part of daily clinical practice.
除了影像学评估外，生物标志物还可能有助于提供治疗反应的早期信息，并支持临床决策。本研究旨在探讨癌胚抗原（CEA）和乳酸脱氢酶（LDH）作为晚期非小细胞肺癌（NSCLC）患者接受铂类化疗后早期评估反应的生物标志物。
这是一项回顾性随访研究，于 2012 年至 2017 年期间在荷兰一家大型教学医院对 593 例接受一线铂类化疗的晚期 NSCLC 患者进行。采用多变量逻辑回归分析预处理生物标志物水平及其与根据 RECIST 1.1 评估的影像学反应（部分缓解[PR]或完全缓解[CR]）的变化之间的关系，采用 COX 比例风险模型分析与总生存的关系。考虑了患者和疾病特征（如年龄和疾病分期）作为潜在混杂因素。
CEA 和 LDH 的降低（≥20%），尤其是在治疗早期，与更好的影像学反应显著相关。这些标志物的升高（≥20%）和高预处理 LDH 水平（≥247 U/L）与总生存降低显著相关。
我们的结果支持在晚期 NSCLC 患者中通过测定 CEA 和 LDH 水平来更早地评估铂类化疗的反应。因此，在晚期 NSCLC 患者接受每轮铂类化疗之前，应考虑常规测定和评估 CEA 和 LDH 水平，并将其作为日常临床实践的一部分。
本研究的重要发现：监测晚期 NSCLC 治疗的血清生物标志物可能有用。CEA 和 LDH 降低（≥20%）有利于获得影像学反应。高 LDH 水平和 CEA/LDH 升高（≥20%）与降低生存率相关。
治疗早期监测 CEA 似乎特别重要。CEA 和 LDH 测定应作为日常临床实践的一部分。
