University of Miami School of Medicine, Sylvester Comprehensive Cancer ... Florida; University of Texas M. D. Anderson Cancer Center, 11 Houston; and the ...
ANNALS OF SURGERY Vol. 226, No. 5, 621-631 © 1997 Lippincott-Raven Publishers
Use of Carcinoembryonic Antigen Radioimmunodetection and Computed Tomography for Predicting the Resectability of Recurrent Colorectal Cancer Kevin Hughes, M.D.,* Carl M. Pinsky, M.D.,t Nicholas J. Petrelli, M.D.,f Frederick L. Moffat, M.D.,§ Yehuda Z. Paft, M.D.I,I Luz Hammershaimb, M.D.,t and David M. Goldenberg, Sc.D., M.D.¶ From the Lahey Hitchcock Medical Center,* Burlington, Massachusetts; Immunomedics, Inc., t Morris Plains, New Jersey; Roswell Park Cancer Institute, t Buffalo, New York; University of Miami School of Medicine, Sylvester Comprehensive Cancer Center,§ Miami, Florida; University of Texas M. D. Anderson Cancer Center, 1 Houston; and the Garden State Cancer Center at the Center for Molecular Medicine and Immunology,¶ Belleville, NJ
Objective The objective was to determine the role of arcitumomab (CEA-Scan; Immunomedics, Morris Plains, NJ), an anticarcinoembryonic antigen (CEA) Fab' labeled with technetium99m, in the presurgical evaluation of patients with recurrent or metastatic colorectal carcinoma.
Summary Background Data Surgical resection is the only method known to cure recurrent or metastatic colorectal carcinoma. The location and extent of disease must be determined before surgery. The role of antibody imaging, a new cancer detection modality, in preoperative evaluation for resection of locally recurrent or metastatic colorectal cancer has not been established, either alone or in combination with standard diagnostic modalities.
Methods In a blinded analysis of 209 patients with known or suspected colorectal cancer, the accuracy of arcitumomab, alone and combined with computed tomography (CT), was compared to that of CT for predicting abdominopelvic tumor resectability by correlating the results with surgical and histopathologic findings.
Results Arcitumomab alone or combined with CT was found to be significantly more accurate for predicting surgical outcome than CT alone. When the results of CT and arcitumomab were concordant for abdominopelvic resectability, nonresectability, or absence of disease, the prediction was accurate in 67%, 100%, and 64%, respectively. Thus, the concordance for nonresectability (100% correct) may obviate the need for other diagnostic modalities or exploratory surgery. When the two tests were discordant, arcitumomab was correct substantially more often than CT.
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Because the liver is the most common site of distant metastasis in colorectal cancer, a subset of patients with hepatic disease was also analyzed; findings were similar to the overall resectability results. The product's safety profile was excellent: the incidence of induction of an immune response against arcitumomab was
