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Table 1. Summary of in vivo studies defining the relevance of CA 19-9 in pancreatic cancer and treatment efficacy
Cell lines Study design Treatment(s) Biomarker Finding(s) Ref.
Orthotopic xenograft To determine the efficacy of Targeted CA 19-9 There was a significant [27]
mouse models, DanG targeted immunocytokine immunocytokine L19- correlation between serum
and MiaPaca L19-IL-2 in PDAC model IL-2 CA 19-9 concentrations and
by evaluating the CA 19-9 tumour volume. CA 19-9 levels
levels for assessing tumour were significantly reduced
progression following L19-IL-2 treatment
PDAC: pancreatic ductal adenocarcinoma; CA 19-9: carbohydrate antigen 19-9

Table 2. Summary of human studies defining the relevance of CA 19-9 in pancreatic cancer and treatment efficacy
No. Study design Treatment(s) Biomarker Finding(s) Ref.
1. To assess serum CA 19-9 levels with (1) Nanoliposome CA 19-9 CA 19-9 levels were significantly lower in [28]
the response rates of chemotherapeutic irinotecan (nal-IRI) patients receiving nal-IRI plus 5 FU/LV than
agents, nanoliposome irinotecan (nal- plus 5-fluorouracil / those receiving oxaliplatin plus. Also, the
IRI) plus 5-fluorouracil/ leucovorin (5- leucovorin (5-FU/LV) median PFS and OS in patients who received
FU/LV) as a second-line treatment (2) Oxaliplatin plus nal-IRI plus 5 FU/LV were significantly longer
option, and compare the responses with fluoropyrimidines compared to those receiving oxaliplatin plus
oxaliplatin plus fluoropyrimidines fluoropyrimidines
2. To evaluate CA 19-9 levels to determine Modified- CA19-9 CA 19-9 levels were found to be decreased [29]
modified-FOLFIRINOX responses in FOLFIRINOX (FOL) following modified-FOLFIRINOX treatment
metastatic PDAC patients
3. To determine the prognostic significance Neoadjuvant therapy CA 19-9 CA 19-9 stats indicated no increase following [30]
of CA 19-9 levels following neoadjuvant NT
therapy (NT) in PDAC patients
4. To study the changes in CA 19-9 levels Nab-paclitaxel plus CA 19-9 Decreased CA 19-9 levels in each of the two [31]
as a predictor of OS in a randomized gemcitabine treatments (nab-paclitaxel plus gemcitabine
phase III trial vs. vs gemcitabine alone). Improved efficacy of
Gemcitabine-alone combination treatment was observed with a
decrease in CA 19-9 levels and patients had
better outcomes compared with gemcitabine
alone
5. To investigate CA 19-9 levels and their FOLFIRINOX (FOL) CA 19-9 Decreased CA19-9 levels were observed [40]
dynamics during neoadjuvant treatment vs. following treatment with FOL, and patients
(NT) in predicting resectability and Gemcitabine-based had significantly higher resection rates
survival NT
6. To determine CA 19-9 levels and Neoadjuvant therapy, CA 19-9 Patients with < 50% increase in CA19- [41]
correlate the results between borderline FOLFIRINOX 9 levels had longer survival than patients
resectable pancreatic cancer (BRPC) with > 50% increase in CA19-9 levels. FOL
vs. initially resectable pancreatic cancer treatment followed by neoadjuvant therapy
(IRPC) receiving neoadjuvant therapy significantly improved the survival response
in BRPC patients
7. To study the diagnostic accuracy of Induction CA 19-9 There was a significant decrease in CA 19-9 [42]
serum CA 19-9 in combination with chemotherapy levels following chemotherapy. An increase in
RECIST-response on CT-imaging in the CA 19-9 level was significantly correlated
predicting the resectability of locally with decreased survival
advanced pancreatic cancer (LAPC)
following induction chemotherapy
8. To evaluate the efficacy of adjuvant Adjuvant CA 19-9 Adjuvant chemoradiotherapy increased the [43]
chemoradiotherapy by assessing chemoradiotherapy surgical outcome in patients with increased
postoperative serum levels of CA 19-9 levels of the CA 19-9 but not in patients with
normal levels of CA 19-9
9. To assess CA 19-9 serum levels as a Any treatment CA 19-9 The resectability in the majority of patients [34]
biomarker in predicting the resectability was accurately predicted by the serum CA
of PDAC mainly in jaundiced patients 19-9 level. Also, the area under the ROC
curve in patients with jaundice corresponded
well with the findings obtained for non-
jaundiced patients
10. To develop an integrated predictive Chemoradiotherapy CA 19-9 CA 19-9 was one of the significant factors [44]
model to determine longer survival which contributed to favourable PFS. In
in locally advanced pancreatic addition, decreased CA 19-9 levels and
cancer (LAPC) patients treated with surgical resection following CRT treatment
chemoradiotherapy (CRT) were significantly associated with higher OS

PDAC: pancreatic ductal adenocarcinoma; CA 19-9: carbohydrate antigen 19-9; TFFs: trefoil factors; LAPC: locally advanced pancreatic
cancer; PFS: progression-free survival; RECIST: response evaluation criteria in solid tumours; CRT: chemo radiation therapy