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Use of Tumor Markers in Gastrointestinal Cancer: 2006 Update Clinical Practice Guideline

Use of Tumor Markers in Gastrointestinal Cancer: 2006 Update Clinical Practice Guideline. Introduction. ASCO convened an Update Committee to review and update recommendations for the use of tumor markers in gastrointestinal (GI) cancers.

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Use of Tumor Markers in Gastrointestinal Cancer: 2006 Update Clinical Practice Guideline

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  1. Use of Tumor Markers in Gastrointestinal Cancer: 2006 Update Clinical Practice Guideline

  2. Introduction • ASCO convened an Update Committee to review and update recommendations for the use of tumor markers in gastrointestinal (GI) cancers. • These guidelines were originally published in 1996 and previously updated in 2000. • The 2006 Update expands the scope of the guideline to include a broader range of markers in colorectal cancer and new evidence on pancreatic cancer markers.

  3. Guideline Methodology: Systematic Review • An ASCO Update Committee completed a review and analysis of data published since 1999 to November 2005 (or from 1966 to November 2005 for new markers): • MEDLINE • Cochrane Collaboration Library

  4. Guideline Methodology (cont’d): Panel Members

  5. Guideline Methodology (cont’d): Panel Members

  6. 2006 Updated Recommendations for GI Tumor Markers • Carcinoembryonic Antigen (CEA) as a Marker for Colorectal Cancer • CA 19-9 as a Marker for Colon Cancer • DNA Ploidy or Flow Cytometric Proliferation as a Marker for Colon Cancer • p53 as a Marker for Colorectal Cancer • ras as a Marker for Colorectal Cancer • TS, DPD and TP as Markers in Colorectal Cancer NEW! • MSI as a Marker in Colorectal Cancer NEW! • 18q-LOH/DCC as Markers for Colorectal Cancer NEW! • CA 19-9 as a Marker for Pancreatic Cancer NEW!

  7. CEA as a Marker for Colorectal Cancer

  8. CA 19-9 as a Marker for Colon Cancer • Present data are insufficient to recommend CA 19‑9 for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.

  9. DNA Ploidy or Flow Cytometric Proliferation Analysis as a Marker for Colon Cancer • Neither flow cytometrically derived DNA ploidy (DNA index) nor DNA flow cytometric proliferation analysis (%S phase) should be used to determine prognosis of early stage colorectal cancer.

  10. p53 as a Marker for Colorectal Cancer • Present data are insufficient to recommend the use of p53 expression or mutation for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.

  11. ras as a Marker for Colorectal Cancer • Present data are insufficient to recommend the use of the ras oncogene for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.

  12. TS, DPD & TP as Markers for Colorectal Cancer

  13. MSI as a Marker in Colorectal Cancer • Microsatellite Instability (MSI) ascertained by PCR is not recommended at this time to determine the prognosis of operable colorectal cancer nor to predict the effectiveness of 5-FU adjuvant chemotherapy.

  14. 18q-LOH/DCC as Markers for Colorectal Cancer • Assaying for loss of heterozygosity (LOH) on the long arm of chromosome 18 (18q) or DCC protein determination by immunohistochemistry (IHC) should not be used to determine the prognosis of operable colorectal cancer, nor to predict response to therapy.

  15. CA 19-9 as a Marker for Pancreatic Cancer

  16. Summary

  17. Additional ASCO Resources • This slide set, a GI tumor marker matrix, and additional resources can be accessed at: http://www.asco.org/guidelines/gitm • A patient guide can be accessed at the website above or at http://www.cancer.net

  18. ASCO Guidelines

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