Patients with pancreatic cancer marker should receive chemo before surgery

Only 19% of patients with pancreatic cancer are tested for the tumor marker CA 19-9 at diagnosis, a new study shows. Failing to test for, and address, elevated CA 19-9 results in many pancreatic cancer patients undergoing resection surgery although they should have been treated with chemotherapy first, according to researchers who are presenting their findings November 9, 2015 at the Western Surgical Association annual meeting in Napa, CA.

In this study, researchers at Mayo Clinic in Rochester, MN, analyzed outcomes data of 97,000 pancreatic cancer patients taken from the National Cancer Data Base. An unexpected finding was that only 1 in 5 (19%) of patients had their CA 19-9 checked at diagnosis, the researchers found.

The other key finding was that patients with pancreatic cancer who had elevated CA 19-9 levels tended to have worse outcomes than others at the same stage of cancer. Elevated CA 19-9 independently predicted increased mortality, particularly in stage 1 patients, they found.

“When we looked at how these patients did after surgical removal of their cancers, the only treatment sequence that completely eliminated the increased risk posed by CA 19-9 elevation was chemotherapy followed by surgical removal of the tumor,” said senior author Mark Truty, MD, a gastrointestinal surgical oncologist at Mayo Clinic.

“This is another argument for giving chemotherapy before surgery in all pancreatic cancer patients and ending the old practice of surgery followed by chemo,” he said. “The study answers an important clinical question and applies to every pancreatic cancer patient being considered for surgery.”

The CA 19-9 test has been standard for pancreatic cancer patients at Mayo Clinic for years, he noted.

“Our conclusion is that every patient should have a CA 19-9 test at diagnosis. This is a simple, cheap, and widely available test that allows personalization of pancreatic cancer treatment,” Dr. Truty said. “Further, patients with any elevation of CA 19-9 should be considered for preoperative chemotherapy to eliminate this risk.”