Blood CEA level increase after taking Tarceva for a while - 1255975

Hello li,

For most patients, CEA does not tend to be a very reliable indicator of progression in lung cancer. The 2 best ways to determine how a patient is responding to treatment is how they feel and what shows up on scans. Since your dad's fever seems to be caused by his cold, he apparently has no symptoms that would indicate that Tarceva is no longer effective, so unless that changes or a follow-up scan shows progression, there doesn't seem to be a reason to change treatment.

Some links to discussions of CEA in lung cancer:

Serum tumor markers in lung cancer, including CEA:
http://cancergrace.org/lung/2007/06/16/tumor-markers-in-lung-cancer/

According to a previous post from Dr. Weiss: "For some patients, CEA correlates well with the amount of disease, but the best data indicate that it's just not that good a test. There are no clearly good blood markers for monitoring disease in NSCLC."

http://cancergrace.org/forums/index.php?topic=3950.msg23396#msg23396

Here's another post from Dr. West with a little more detail about how he interprets CEA.
http://cancergrace.org/forums/index.php?topic=742.msg3874#msg3874

Interpreting Dr. West's post: the CEA marker doesn't seem that valuable on its own, but it can be combined with scan results to provide more information. It is of some utility, but not enough to override scan results.

Dr. West posted that he's less concerned with the actual CEA number, but rather whether it's going up or down or staying stable:

"I'd rather have a CEA (or some other tumor marker) go from 30 to 20 than from 6 to 12, and having a CEA of 200 isn't twice as bad as one that is associated with a CEA of 100. Some cancers just happen to make these measurable proteins, while others don't. And even if the CEA were normal, it wouldn't have a different meaning than a slightly elevated CEA in someone known to have started with metastatic disease."
http://cancergrace.org/forums/index.php?topic=2608.0;wap2

JimC
Forum moderator

CEA may possibly be associated with progression of the cancer, but I and most other lung cancer consider it a tragically awful idea to conclude there is clinically significant progression if there isn't also evidence of progression based on repeat imaging. As your question suggests, there are other causes of elevated CEA, and even if we knew that the cancer is correlated with CEA levels, I would submit that if the cancer isn't progressing enough to lead to growing lesions or new evidence of disease on imaging, it isn't clinically significant progression. So while I consider it reasonable to use a rising serum tumor marker like CEA as a trigger to favor more diligent imaging and perhaps clinical assessment (new symptoms?) to suggest progression, I have absolutely no enthusiasm for making treatment changes on the basis of a CEA rise alone, in the absence of evidence of clinically or radiographically (scan-based) progression of disease.

Nobody has ever died of a rising CEA.

-Dr. West

Hi, Not to be alarmist, but I have a similar situation and want to relate to help you in decision making. I have been on tarceva since December 2011 cancer free on pet scans. My CEA, which has been low since my initial chemo (around 1) crept up to 1.5 in March (which I attributed to some infection I had at the time), then 2.5 last month. Have not gotten this month's number, but did have a brain scan which I do routinely every six months yesterday and this time I had 3 small mets which will be gamma knifed out next week. I am going to have another petscan next week too (moved up by about 3 weeks) to make sure there is no other spread. My CEA is low, but that sudden creep up might have been a sign that something was progressing.

I wouldn't panic for a one month rise especially when there is infection. Hopefully it will either come down or stabilize. But, if it continues to go up, even if low and within normal like mine, it might at least be a time to voice concerns to the doctor and to push up any scans that might be due.

I remain asymptomatic. You would not know there is anything wrong with me. Thank goodness for all of these great knowledge resource websites that have helped me to self advocate.

I don't think it's wrong to use a rising CEA to consider the timing of repeat scans. I just think it's a mistake to use a serum tumor marker for lung cancer without any corroborating evidence from imaging to decide a cancer is progressing and there is a need to start or change treatment solely on the basis of the changing tumor marker if there is no evidence of progression on scans.

-Dr. West