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Thread: chemo and CA 19-9

  1. #1

    chemo and CA 19-9

    Hi. I know this has been discussed before, but I can't find details. Has anyone here had the experience of starting FOLFIRINOX and seeing the CA 19-9 rise after the first treatment? Thanks.
    February 2016- diagnosed with PC
    March 2016- inoperable due to arteries, also liver mets suspected
    March 2016-January 2017 -Gemzar/Abraxane
    February 2017 surgery-PC tumour and liver mets removed at same time
    July 2018 Back on Gemzar/Abraxane due to rising CA 19-9. Scans were clear.

  2. #2
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    Yes. Not on folfirinox but with my first treatment of gem,abrx,cis. Went from 124,000 to 146,000. I didn't freak since by that time I had read that this happens. After that it started dropping precipitously.

  3. #3
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    What's up?

  4. #4
    Thank you SO much. I had my first round of FOLFIRINOX last month and the number was 1900. Before I got hooked up for the second treatment, I found out the number is over 3700.
    February 2016- diagnosed with PC
    March 2016- inoperable due to arteries, also liver mets suspected
    March 2016-January 2017 -Gemzar/Abraxane
    February 2017 surgery-PC tumour and liver mets removed at same time
    July 2018 Back on Gemzar/Abraxane due to rising CA 19-9. Scans were clear.

  5. #5
    Super Moderator Top User ddessert's Avatar
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    Jackie, this is common for people whose chemotherapy is effective. I find it somewhat troubling in your case because we’ve never been sure that you’ve had a recurrence. But this response kinda points towards a real recurrence.

    On a related note, I’ve been telling people recently that the best year of my life has been the period between my initial treatment and surgery. During this time, my tumor never grew and I was still ineligible for surgery. I think that the idea that I had an expiration date that was known to be coming soon really allowed me to live like there was no tomorrow. There was no putting off experiences. I’m wondering if you experienced something like this as well?

    This same experience is something I’ve been hoping for my dad. He’s stage 4 but with a potentially really effective treatment in front of him. I’d like to have him experience a year or two before the ultimate flame-out.
    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

  6. #6
    Dear David,
    I need to update my signature. I can't recall how. Yes, a real recurrence was established about five weeks ago. A small lesion (5-7 mm) was detected on the liver via a PET scan. So, does this mean that it is not unusual, and in fact quite normal, for there to be an initial spike when the chemo is working?
    I know what you mean about the best years of our lives. I have traveled quite a bit since diagnosis, and have had lots of visits from friends. I think we all realize, none of us ever knows when the end will be. We have stopped putting things off. I try to do and enjoy as much as I can.
    I couldn't quite understand from your post about your dad. What is the potentially really effective treatment he has in front of him?

    Thanks!
    Last edited by jackieb501; 04-07-2019 at 10:36 AM. Reason: mistake cm changed to mm
    February 2016- diagnosed with PC
    March 2016- inoperable due to arteries, also liver mets suspected
    March 2016-January 2017 -Gemzar/Abraxane
    February 2017 surgery-PC tumour and liver mets removed at same time
    July 2018 Back on Gemzar/Abraxane due to rising CA 19-9. Scans were clear.

  7. #7
    Super Moderator Top User ddessert's Avatar
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    I would consider a spike in CA19-9 more promising than a steady increase just after starting a new chemo. You’re just going to have to wait until the next blood draw to find out.

    Dad I’d getting a platinum-based treatment (GemOx) because of his germline BRCA2 mutation. That treatment would not be very effective for people without BRCA2 (or BRCA1, PALB2, or associated) mutations.
    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

  8. #8
    Thank you, David. Would the best case scenario, though, be a drop after getting new treatment?
    February 2016- diagnosed with PC
    March 2016- inoperable due to arteries, also liver mets suspected
    March 2016-January 2017 -Gemzar/Abraxane
    February 2017 surgery-PC tumour and liver mets removed at same time
    July 2018 Back on Gemzar/Abraxane due to rising CA 19-9. Scans were clear.

  9. #9
    Super Moderator Top User ddessert's Avatar
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    Yes.

    But for others watching this thread, it may not always be the same answer for them. You have some history with your CA19-9 numbers and you are not battling some of the CA19-9 elevating complications such as a blocked bile duct, pancreatitis, or several others. Those factors tend to make CA19-9 much harder to correlate with tumor burden.
    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

  10. #10
    Experienced User
    Join Date
    Dec 2017
    Posts
    86
    Hi Jackie, hope your new treatment will work.

    CA19-9 is an antigen in certain cells in the digestive system, including cancer cells mutated from normal cells. When these cells die, CA19-9 is released to blood and can be detected.

    So just to think about it, it makes sense that Ca19-9 marker can be spiking, when a newly administrated treatment effectively kills cancer cells and releases lots of this substance into blood all of sudden.

    After this initial spike, you would want to see Ca19-9 start to drop.
    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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