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a Institute of Clinical Chemistry, University Hospital of Munich-Grosshadern, Munich, Germany b Department of Oncology, Asklepios Hospital Gauting, Munich, Germany c Institute of Clinical Chemistry, Asklepios Hospital Gauting, Munich, Germany
Key Words: DNA • nucleosomes • cytokeratin-19 fragments • CYFRA 21–1 • serum • plasma • prediction • chemotherapy • lung cancer
Address for correspondence: Dr. Stefan Holdenrieder, Institute of Clinical Chemistry, University Hospital of Munich-Grosshadern, Munich, Germany. Voice: 0049-89-7095 3231; fax: 0049-89-7095 6298. e-mail: Stefan.Holdenrieder{at}med.uni-muenchen.de
Facing an era of promising new antitumor therapies, predictors of therapy response are needed for the individual management of treatment. In sera collected prospectively from 311 patients with advanced non-small cell lung cancer receiving first-line chemotherapy, changes in nucleosomal DNA fragments, cytokeratin-19 fragments (CYFRA 21–1), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and progastrin-releasing peptide (ProGRP) were investigated and correlated with therapy response. In univariate analysis, high levels, slower and incomplete decline in nucleosomal DNA, CYFRA 21–1, and CEA predicted poor outcome. DNA concentrations at day 8 of the first therapeutic cycle and CYFRA 21–1 before start of the second cycle were identified as best predictive variables. In multivariate analysis, they predicted progression with a specificity of 100% in 29% of the cases earlier than imaging techniques. Thus, nucleosomal DNA and CYFRA 21–1 specifically identify a subgroup of patients with insufficient therapy response at the early treatment phase and showed to be valuable for disease management.
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