CEA Is Not a Clinically Relevant Biomarker in Anal Cancer

Oncotarget published "CEA as a blood-based biomarker in anal cancer" which reported that the mean Carcinoembryonic Antigen (CEA) among subgroups by clinical status at the time of presentation to our institution was highest among those patients with metastatic Squamous cell carcinoma of the anal canal (SCCA) to visceral organs, however this finding was not statistically significant by ANOVA .

By clinical subgroup, the percentage of patients with an abnormally elevated CEA was highest in those patients with metastatic disease to lymph nodes followed by recurrent/unresectable SCCA , and metastatic SCCA to visceral organs, and was statistically significant between groups.

Using RECIST criteria for tumor progression and disease response, the mean change in CEA for patients with progression was an increase in 19 ng/mL, compared to a change of –7.3 ng/mL in those with disease response.

The authors likewise assessed whether CEA levels were associated with survival outcomes for all patients with metastatic SCCA, and found no correlation between CEA and likelihood for survival in a ROC analysis.

Despite interesting patterns of abnormally high CEA in SCCA patients with advanced disease, and correlation of increased CEA with disease progression, CEA is not associated with survival outcomes in SCCA, and is not a clinically relevant biomarker in this disease.

CEA is not associated with survival outcomes in SCCA, and is not a clinically relevant biomarker in this disease

Dr. Van K. Morris from The University of Texas - MD Anderson Cancer Center said, "Squamous cell carcinoma of the anal canal (SCCA) is a rare cancer of the anogenital track with an estimated incidence of about 8500 new cases and 1350 deaths in 2020 in the U.S. annually, comprising 2–3% of all gastrointestinal malignancies."

Routine, readily available blood-based markers are often utilized in the clinical management of patients with solid tumors across a variety of clinical settings.

For example, trends in biomarkers such as carcinoembryonic antigen, carbohydrate antigen 19-9, prostate-specific antigen and carbohydrate antigen 125 can be monitored serially over time for patents with colorectal cancer, pancreatic cancer, prostate cancer, and ovarian cancer, respectively, as a surrogate for changes in amount of tumor present.

To date, no blood-based biomarker for tracking responses to HPV-associated cancers is readily available to clinical oncologists for routine use.

Among anal cancer patients, one series examined 106 patients with early-stage SCCA treated definitely with chemoradiation and did not find clinical utility in the measurement of CEA in this subset of patients with anal cancer.

Since no blood-based biomarkers are currently available in a CLIA-certified laboratory for the routine management of SCCA, we performed a retrospective, single-institution study to correlate serum CEA levels with clinical and pathologic outcomes in patients across all stages and presentations of SCCA.

The Morris Research Team concluded in their Oncotarget Research Output, "we report the largest series to describe CEA as a serum biomarker for patients with metastatic SCCA. Our findings may not provide definitive support for the use of a routinely used blood-based assay for management of patients with SCCA and should guide clinicians in seeking alternative approaches for tracking responses to treatment in this disease. Nonetheless, novel approaches with serum biomarkers are needed for patients with this rare but increasingly diagnosed malignancy."

Reference: Hester R, Advani S, Rashid A, et al. CEA as a blood-based biomarker in anal cancer. Oncotarget. 2021;12(11):1037-1045. doi: 10.18632/oncotarget.27959

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