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Thoughts on CA19 behavior close to nadir

Posted by peterello @peterello, Jul 31 9:46am

Got diagnosed in Dec with all tests completed mid Jan. Started chemo in late Jan. Stage IV with mets in liver and lungs.

Looks like I've responded well to chemo and mets are stable or reducing in lungs and no longer visible in liver on CT scan. Main pancreatic lesion down from 6x5cm to 4x3.

I'm getting little bit worried (probably for nothing) but after 11 infusion of constant CA19 drop I got a small uptick (from 56 to 61). Should I expect the worst from next measurement? Or am I at a level relatively low that small fluctuations up (or down) can be nothing to do with tumor?

Markers test always done in the same lab the day before chemo. Markers were skipped couple of times and had to postpone chemo three times by few days to up a week.

Anyone that has any direct experience with CA19 behavior approaching nadir would be nice. Also I'm bit puzzled as CA19 never showed any sign of slowdown so far. between infusions the drop has always been around 20% and been very constant in the last 3 / 4 infusions until the most recent uptick.

As CA19 gets close to nadir or reversion shouldn't it give some slowdown signal? Showing my markers since the beginning of treatment to get any thoughts. Also worth mentioning I have diabetes 2 with hba1c at 62 and fatty liver. All bloodwork in range except LDH at 256.

Days CA19 CEA CA125
0 466 8.6 NA
20 573 14 12
35 481 16.9 10
49 326 15.5 10
64 273 17.1 10
99 139 13.2 8
120 108 10.5 8
135 90 9.3 7
174 56 8.7 7
188 61 9.7 7

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mcharlesfrancis | @mcharlesfrancis | 2 days ago

Marlene, 14 days is very early to determine whether RASONque is working, and I would be careful about judging the drug from this CA 19-9 result alone.

Your husband's CA 19-9 was already rising substantially before starting the pill—9,000 → 11,000 → 13,000 → 15,800—so the increase to 18,800 after starting treatment may represent continuation of the disease trend that was already underway. It doesn't necessarily mean that RASONque has failed after only two weeks.

CA 19-9 is useful for following trends, but scans and how the patient is doing are ultimately very important. The first CT after enough time on the drug should give you much more information about whether the tumors are shrinking, stable, or continuing to grow.

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jadees | @jadees | 1 day ago
In reply to @witchypooy "I am so confused. Hubby has been on RASONque for 14 days and his CA 19..." + (show)
Profile picture for witchypooy @witchypooy

I am so confused. Hubby has been on RASONque for 14 days and his CA 19 went from 15800 to 18800 up not down...Also notice I said thousands, not hundreds like you all have. At diagnosis in 10/2024 it was 6000 then chemo kept it steady for 1 year, with treatments every other week. then it started to climb, 9000, 11000, 13000 15800 and now 18800. and in the 1st week of Aug we went on "the pill", however CA 19 is still climbing

We are now considering a combo of the old chemo every 2 weeks and 100 mg of "the pill" to see if there can be some slowing again. On the other had living 22 mos from diagnosis is already above average, and hubby is still able to go to the casino twice a week, using a walker, with a time frame of about 3 hrs.

So everyone is different, and when you think things are bad, I suggest you check out others with this disease and count your blessings. My husband and 2 other patient at his clinic were on the wait list for 2 mos for the pill, and the other 2 patients died while waiting. So given everything, we have a lot of blessings to count.
Good luck
Marlene

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@witchypooy love your attitude , counting the blessings . Make the memories while the going is good enough to do so .

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