Molecular Markers in Solid Tumors: What Clinicians Need to Know: Introduction - solid tumors

For ovarian cancer, in vitro chemotherapy sensitivity and resistance assays are cited as Category 3 recommendations (reflecting major disagreement among NCCN panel members) for the selection of chemotherapy when multiple appropriate chemotherapy choices exist. Such assays are used in a few NCCN Member Institutions but should not supplant standard of care chemotherapy choice due to the lack of evidence for clinical benefit.^[100,101] The NCCN Guidelines™ also recommend that patients with ovarian cancer undergo measurement of serum carbohydrate antigen (CA)-125 levels and "other tumor markers as clinically indicated" at diagnosis, during treatment as markers of response, and as surveillance for disease recurrence.^[102,103] Of note, the European Organization for Research and Treatment of Cancer (EORTC) 55955 trial showed no survival benefit when an elevation in CA-125 levels alone was used to prompt initiation of second-line treatment in 1442 patients with ovarian cancer in remission after first-line platinum-based chemotherapy, suggesting against a role for this marker in surveillance for recurrence.^[104] Other serum markers may include inhibin for sex cord-stromal tumors and HCG, AFP, and LDH for germ cell tumors of the ovary.^[103,105]