abstract: Risk of Malignancy in Sonographically Confirmed Ovarian Tumors

Abstract

Ovarian cancer is the leading cause of gynecologic cancer death in the United States. Once an ovarian tumor is identified, a pelvic ultrasound is recommended, including tumor volume and tumor structure. Unilocular and simple septate tumors are unlikely to be malignant and when asymptomatic, can be safely followed conservatively without surgery. Complex ovarian tumors are at an increased risk for malignancy and secondary testing is recommended. Secondary testing may include CA125, OVA1, the RMI, ROMA, or the ACOG referral guidelines. When secondary testing indicates that an ovarian tumor is at high risk for malignancy, referral to a gynecologic oncologist is recommended.

abstract: Predictive value of serum CA-125 levels in patients with persistent or recurrent epithelial ovarian cancer or peritoneal cancer treated with Bevacizumab (Avastin) Gynecologic Oncology Group phase II trial

Purpose

To compare two methods of determining therapeutic response and disease progression — modified Gynecologic Cancer Intergroup (GCIG) criteria based on CA-125 and Radiographic Evaluation Criteria in Solid Tumors (RECIST), in a phase II trial of bevacizumab for patients with recurrent or persistent epithelial ovarian and peritoneal carcinoma.

Results

Sixty-two patients were evaluable by RECIST, 59 for progression by CA-125, and 45 for response by CA-125..........

Conclusions

In this study, disease assessment by RECIST and CA-125 appears to correlate in general. However, approximately 10% of patients might demonstrate progression earlier by CA-125.

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Highlights

► CA125-defined response and progression were assessed for women with recurrent ovarian cancer.
► CA125 and RECIST-defined response and progression correlated in most cases, but CA125 progression significantly preceded RECIST in 8 cases.
► CA125-defined response to bevacizumab was associated with a statistically significant correlation with overall survival.

abstract: Implementing an online tool for genome-wide validation of survival-associated biomarkers in ovarian-cancer using microarray data from 1287 patients.

Abstract

"The validation of prognostic biomarkers in large independent patient cohorts is a major bottleneck in ovarian cancer research. We implemented an online tool to assess the prognostic value of the expression levels of all microarray quantified genes in ovarian cancer patients. First, a database was set up using gene expression data and survival information of 1,287 ovarian cancer patients downloaded from GEO and TCGA (Affymetrix HGU133A, HGU133A 2.0 and HGU133+2 microarrays).

After quality control and normalization only probes present on all three Affymetrix platforms were retained (n=22,277). To analyze the prognostic value of the selected gene, the patients are divided into two groups according to various quantile expressions of the gene. These groups are then compared using progression free survival (n=1,090) or overall survival (n=1,287). A Kaplan-Meier survival plot is generated and significance is computed. The tool can be accessed online at www.kmplot.com/ovar. We used this integrative data analysis tool to validate the prognostic power of 37 biomarkers identified in the literature.

Of these, CA125 (p=3.7e-5, HR=1.4), CDKN1B (p=5.4e-5, HR=1.4), KLK6 (p=0.002,HR=0.79), IFNG (p=0.004, HR=0.81), P16 (p=0.02, HR=0.66) and BIRC5 (p=0.00017, HR=0.75) were associated with survival. The combination of several probe sets can further increase prediction efficiency.

In summary, we developed a global online biomarker validation platform that mines all available microarray data to assess the prognostic power of 22,277 genes in 1,287 ovarian cancer patients.

We specifically used this tool to evaluate the effect of 37 previously published biomarkers on ovarian cancer prognosis."

UK - Ovarian cancer test news is misunderstood says gynaecological cancer charity The Eve Appeal | CA125/NICE guidelines

"In light of recent media coverage following the introduction of new NICE guidelines on ovarian cancer, The Eve Appeal and UCL Gynaecology Cancer Research Centre are concerned that women are misunderstanding the advice recently reported on CA125 blood tests. ..."

Follow-up with CA125 after primary therapy of adva... [Ann Oncol. 2011] - PubMed - NCBI

CONCLUSIONS:

Women should be advised not to have routine CA125 measurements, providing they are well and have no symptoms suggesting relapse. In asymptomatic patients with a rising CA125 level, chemotherapy can be delayed. Earlier stopping of maintenance therapy just because of rising CA125 might deny patients continuing benefit from that therapy. Use of CA125 to define progression could result in platinum-sensitive patients being falsely classified as platinum resistant.

Editorial - no abstract/pay-per-view: - Gynecologic Oncology : More than a biomarker: CA125 may contribute to ovarian cancer pathogenesis

Abstract

Gynecologic Oncology
Volume 121, Issue 3, 1 June 2011, Pages 429-430

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Editorial

More than a biomarker: CA125 may contribute to ovarian cancer pathogenesis

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Robert C. Bast Jr.^{a, ,} and David R. Spriggs^b

^a Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
^b Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA

Available online 19 May 2011.

References

Corresponding author. Unit 1439, U.T. M.D. Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA. Fax: +1 713 792 7864.

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Copyright © 2011 Published by Elsevier Inc.

Editorial: New guidelines for early detection of ovarian cancer : The Lancet

"....NICE advises primary care professionals to measure serum concentrations of the protein CA125 if a woman (especially if older than 50 years) presents on a persistent or frequent basis with abdominal distension, feeling full or loss of appetite, pelvic or abdominal pain, or increased urinary frequency. If the blood test is positive, an ultrasound of the abdomen or pelvis should be done and, if ovarian cancer is suggested, the woman should be referred to a specialist...."