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Thread: CA-19 going up during Chemo

  1. #1

    Question CA-19 going up during Chemo

    Hi - I'm writing on behalf of my mom. She was diagnosed in Nov 2018 with pancreatic cancer - in the tail. CA-19 in the 40's. Was very lucky to catch it when things seemed contained. Had what was called a successful distalpancreatectomy with clear margins and all lymph nodes clear right after Thanksgiving. A CT scan after surgery was also clear around December 20th. She was slated to begin chemo late January, 6-8 weeks following the surgery to be safe.

    She had some pain starting early January, so she went in for another CT scan January 15, 2019. This scan showed the cancer in fact was back and spreading in the area around her abdomen (not the organs directly but the space in between). She started Folfirinox immediately that week. She just finished her 4th cycle (out of 12) and was rescanned. The tumor growth, which had been extremely rapid (growing from nothing to sizable tumors in just 3 weeks Dec-Jan), had stabilized with minimal additional growth and no further metastases since the mid-January scan. However, her CA-19 count has steadily risen at each cycle to now just over 200.

    The oncologist and team are considering changing her treatment to G/A/C and discussing this tomorrow. In the meantime, has anyone else had any experience with rising CA-19 levels through chemo while the tumor growth seems to be helped by the treatment? Does it mean that the FFX isn't working?

    Thanks in advance for any assistance! I have been following this forum since November, and your posts are so helpful.

  2. #2
    Regular User
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    I honestly would not be overly concerned with CA-19 numbers but more with whether or not the tumors are shrinking. My wife's number when down but the tumors didn't -- go figure. Also, if she is on FOLFIRINOX now I would rather they try to finish the cycles before switching to an alternate chemo. Does she also receive 5FU? (That would be on a pump that they send her home on after each FOLFIRINOX treatment).

  3. #3
    Regular User
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    My husband was diagnosed with pancreatic cancer last summer 2018, 51 years old. He had total pancreatectomy surgery in July and discharged as early stage of cancer, no lymph node involved. He started chemo therapy, gemzar for 6 months from August 2018 and done Jan 2019. The CA 19-9 from 355 down to 35 then went up at cycle 4 and after he finished the chemo at the end of Jan 2019, his CA19-9 went up to 258 and now is 1400. Dr. Sent him to do ct scan, PET scan, MRI but the results are normal. He started with some back pain and abdominal pain and losing weight. The oncologist wants to do laparoscopic to see inside his abdominal on April 8, 2019. I’m not sure if he has recurrence or not and it seems the Gemzar didn’t work. We registered at Pancreatic Cancer network and enrolled the know my tumor, Tempus (the laboratory who performs molecular testing) will order the molecular testing, as well as a kit to collect a blood sample that is sent as part of the testing process for free. The Know Your Tumor report includes treatment options, which are determined after report findings are interpreted by an expert panel, providing valuable insight to support your treatment decisions.

  4. #4
    Super Moderator Top User ddessert's Avatar
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    It sounds like the tumor cells may be in the peritoneum ("in the area around her abdomen (not the organs directly but the space in between)"). If so, that area is very difficult for chemotherapy to penetrate due to the lack of blood vessels. Keep on the lookout for fluid build-up in the abdomen. It can be hard to notice in patients who have lost a lot of weight because it makes them look better.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - IMRT+Xeloda
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2019 - NED
    Mar 2013-present - NCT01088789
    Jun 2019- NCT03805919
    @pancanology

  5. #5
    Experienced User
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    My mom was in a similar situation. Her CA-19 rose from normal to 200 during adjuvant chemo (S1, not available in US but widely used in East Asia), and scan later found recurrence in her peritoneum. We switched to G/A right away, which has been working quite well for about 8 months now.

    I'm not trying to suggest any chemo may or may not work for your mum, coz every patient and their cancer are different. Switching chemo means taking chances, given that current chemo has stabilized the disease. So it really depends on what your mom really wants.
    Oct 2017 - Mom's annual checkup found elevated CA19-9 (280 kU/L)
    Nov 2017 - Diagnosed. Pancreatic Adenocarcinoma on body/tail of pancreas, ~3cm mass
    Dec 2017 - Distal pancreatectomy, 3.5*3*2 mass removed, 2/17 lymph nodes.
    Jan 2018 - CA19-9 dropped to 30 kU/L 4 weeks after surgery.
    Feb 2018 - 3 rounds of S1
    June 2018 - CA 19-9 from 50 to 170 KU/L. CT + PET confirmed recurrence at remainder of pancreas + peritoneal mets.
    July 2018 - Started Gem/Abraxane
    Sep 2018 - Peritoneal mets disappeared on CT. CA 19-9 dropped to 35.
    Nov 2018 - Finished 4th round of Gem/Abraxane. Clear CT. CA19-9 dropped to 22.

 

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