A widely available and inexpensive blood test – a CA 19-9 tumor marker test – helps predict outcomes and guide treatment decisions among patients with pancreatic cancer. But despite its clear benefit, only one in five U.S. pancreatic cancer patients receive the blood test at diagnosis.
Unfortunately, this means many pancreatic cancer patients with operable disease may undergo treatment that is not as beneficial as it could be, specifically surgery followed by chemotherapy.
According to an analysis of 97,000 pancreatic cancer patients presented at the Western Surgical Association annual meeting in Napa, California, those with higher levels of CA 19-9 (carbohydrate antigen 19-9) tended to have worse outcomes than others with lower levels.
However, receiving chemotherapy before having surgery eliminated this negative effect. Senior author Mark Truty, M.D., a gastrointestinal surgical oncologist at Mayo Clinic in Rochester, Minnesota, explained to Medical News Today:
“This is another argument for giving chemotherapy before surgery in all pancreatic cancer patients and ending the old practice of surgery followed by chemo … The study answers an important clinical question and applies to every pancreatic cancer patient being considered for surgery.”
The researchers concluded the test, which costs about $170, should be given to every pancreatic cancer patient at diagnosis as a way to personalize cancer treatment.
Among people with stage I cancer and elevated CA 19-9 levels, survival rates were cut in half if they received surgery before chemo. So if any elevation of CA 19-9 is discovered, the patient should consider chemotherapy prior to surgery in order to eliminate an increased risk of poor outcomes.
This may require some rethinking of the current standard of care, which typically prioritizes surgery first. But as Dr. Truty explained in Medscape:
“In a tumor that’s otherwise removable, everyone’s always afraid of missing some opportunity [that the tumor will metastasize before surgery]. That’s not how things work. If the tumor metastasized, it metastasized long before the diagnosis.”
Although the results are considered preliminary until published in a peer-reviewed journal, Dr. Truty believes the approach should be widely adopted by health care institutions, noting:
“I definitely think this is something that needs to be incorporated. It’s cheap, widely available, and it’s a quick way to determine how best to treat these patients.”