ONCAlert | 2017 San Antonio Breast Cancer Symposium
Pancreatic Cancer Case Studies

George P. Kim, MD: Importance of CA19-9 and Albumin Markers

George P. Kim, MD
Published Online:Sep 23, 2016
Henry R was diagnosed with adenocarcinoma in the body of the pancreas when he was 64 years old, following rapid weight loss, abdominal pains, and the development of venous thrombosis. 

Metastatic Pancreatic Cancer With George P. Kim, MD, and Eileen M. O'Reilly, MD: Case 2

Metastatic Pancreatic Cancer With George P. Kim, MD, and Eileen M. O'Reilly, MD: Case 1
Metastatic Pancreatic Cancer With George P. Kim, MD, and Eileen M. O'Reilly, MD: Case 2


What is the importance of markers such as CA19-9 and albumin for diagnosis and response prediction in pancreatic cancer?

The importance of CA19-9 and albumin are really of a prognostic nature. High CA19-9s in patients are associated with potentially poorly differentiated cancers, which may be more aggressive and for which there are worse prognoses. So that’s the importance in CA19-9. Unfortunately, it is not a screening tool for pancreas cancer. We don’t have any screening tools. As we said earlier, it is very important that these be developed. It can be used to monitor treatment, but you really have to be cautious and not change chemotherapy treatment based on the changes in the CA19-9. You really must rely on patient’s symptoms and importantly, radiographic progression. I would not recommend using CA19-9 to change treatments. You’ve got to stick with the treatments for as long as they benefit patients, and that’s why I don’t use tumor markers to make treatment decisions. It may prompt you to perform earlier diagnostic or restaging studies. That may make sense but not to change treatment. The importance of albumin is it gives us a sense of the patient’s nutritional state. Certainly patients that have low albumin may have been afflicted with the cancer for a longer period of time and they have greater nutritional needs. You have to be aggressive in getting the right amount of caloric intake, make sure they’re benefitting from antiemetics, de-gassing agents. Also, if they’re having weight loss and diarrhea, they should be on pancreas replacement enzymes. So the albumin is prognostic and it gives us a measure of how the patients are doing from a nutritional aspect.

Metastatic Pancreatic Cancer: Case 2

Henry R was diagnosed with adenocarcinoma in the body of the pancreas when he was 64 years old, following rapid weight loss, abdominal pains, and the development of venous thrombosis. 

  • At diagnosis, measurable distant lymph node, liver, and lung metastases were observed
  • His CA19-9 level was 2760 U/ml and his concentration of albumin was 28 g/L. His ECOG performance status was 1.

Upfront treatment was administered with nab-paclitaxel and gemcitabine, which lasted for 4months:

  • At the time of progression, pain levels had increased interfering with daily activity and raising the ECOG performance status to a 2.
  • At this point, second-line therapy was initiated with liposomal irinotecan, fluorouracil, and folinic acid.
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