paywalled: Role of HE4, CA72.4, and CA125 in monitoring ovarian cancer.

Role of HE4, CA72.4, and CA125 in monitoring ovarian cancer.

Abstract

The aim of this study was to investigate the role of biomarkers CA125, HE4, and CA72.4 at diagnosis and throughout the follow-up in patients with epithelial ovarian cancer (EOC). Thirty-nine patients with EOC were deemed eligible, and 20 were followed up. CA125, HE4, and CA72.4 serum levels were determined for all patients at initial diagnosis of EOC. Among these patients, the number of cases with an elevated level of each individual marker was CA125 77 %, HE4 85 %, and CA72.4 72 %. A statistically significant difference was observed between the level of HE4 when compared to CA72.4 (p < 0.02). In the follow-up phase, we observed tumor marker levels fluctuating according to response to chemotherapy. When combining two out of the three biomarkers together, we observed increased values of CA125 and CA72.4 in 55 % of the patients, increased values of CA125 and HE4 in 65 % of the patients, and finally increased HE4 and CA72.4 in 75 % of the patients. A statistically significant difference was observed when combining HE4 and CA72.4, but not CA125 and CA 72.4 (p < 0.002). In conclusion, our study demonstrates that the association of three biomarkers CA125, HE4, and CA72.4 provides a valuable contribution in the follow-up of EOC patients.

open access: CA-125: To Monitor or Not to Monitor?: Evidence Against Monitoring CA-125 For Ovarian Cancer Patients in Remission (Dr's Rustin, Karlan, Markman)

CA-125: To Monitor or Not to Monitor?: Evidence Against Monitoring CA-125

 For Ovarian Cancer Patients in Remission

Gordon Rustin, MD; Beth Y. Karlan, MD; Maurie Markman, MD

Authors and Disclosures

Posted: 03/08/2012

Editor's Note:
 
CA-125 is the most useful tumor marker in ovarian cancer. Since 1981, measurement of the serum level of the CA-125 antigen has become a standard component of routine management of women with advanced ovarian cancer.^[1,2] CA-125 concentrations are used to monitor response to chemotherapy, relapse, and disease progression in ovarian cancer patients. However, the question remains as to whether routine monitoring of CA-125 in women with advanced ovarian cancer in complete remission is advantageous. Recently, Drs. Gordon Rustin and Beth Karlan -- experts in the treatment of ovarian cancer -- participated in a Medscape Virtual Debate via email addressing the question, "Should patients with advanced ovarian cancer in complete remission undergo routine CA-125 monitoring?" Dr. Maurie Markman served as moderator. What follows is their conversation..........cont'd

abstract: Follow-up care amongst long-term childhood cancer survivors: A report from the Swiss Childhood Cancer Survivor Study (age ranges 20-49)

The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review

CONCLUSION: Ultimately, serial imaging and the CA-125 assay detected the highest number of ovarian cancer and PCC progressive disease cases in comparison to physical examination and vaginal cytology, but nevertheless, all of the procedures were conducted at a considerable financial expense.

repost with update: National Guideline Clearinghouse | ACR Appropriateness Criteria® staging and follow-up of ovarian cancer

Note: focus is on:

Major Outcomes Considered

Utility of radiologic examinations in differential diagnosis

Guideline Title

ACR Appropriateness Criteria® staging and follow-up of ovarian cancer.

Bibliographic Source(s)

Expert Panel on Women's Imaging. Staging and follow-up of ovarian cancer.: American College of Radiology (ACR).

How to follow up advanced-stage borderline tumours? Mode of diagnosis of recurrence in a large series stage II-III serous borderline tumours of the ov

BACKGROUND: The aim of this study was to describe how recurrences were diagnosed in the largest series of patients treated for an advanced-stage serous borderline ovarian tumour.
PATIENTS AND METHODS: From 1973 to 2006, 45 patients with a serous borderline tumour and peritoneal implants relapsed among 162 patients with a follow-up exceeding 1 year. Data concerning recurrences and the mode of diagnosis were reviewed.
CONCLUSIONS: This study demonstrates that ultrasound is the most relevant follow-up procedure in this context. Nevertheless, the blood CA 125 test is of particular interest for detecting invasive recurrent disease, which is the most crucial event.

abstract: How to follow-up patients with epithelial ovarian cancer : Current Opinion in Oncology

How to follow-up patients with epithelial ovarian cancer
Miller, Rowan E; Rustin, Gordon JS

Abstract

Purpose of review: Despite optimal primary treatment most patients with advanced epithelial ovarian cancer will relapse. This review discusses the controversy regarding surveillance and the timing of treatment for recurrent disease.

Recent findings: Routine physical examination has a limited role in the detection of recurrent ovarian cancer. PET/computed tomography (CT) has been shown to be useful in detecting small volume disease not apparent on traditional imaging in patients with suspected recurrence based on symptoms and/or rising CA125. The results of PET/CT can alter treatment plans and have particular use in guiding site-directed therapy. The benefits of early detection and systemic treatment of recurrence are now in doubt following the presentation of the MRC/EORTC CA125 surveillance trial. The impact on survival of secondary cytoreductive surgery requires more investigation.

Summary: Uncertainties remain in the surveillance and timing of treatment for relapsed disease. Patients should be informed of these uncertainties and become involved in decisions regarding their follow-up.

abstract: How to follow-up patients with epithelial ovarian cancer : Current Opinion in Oncology

abstract: How to follow-up patients with epithelial ovarian cancer.

Abstract

PURPOSE OF REVIEW: Despite optimal primary treatment most patients with advanced epithelial ovarian cancer will relapse. This review discusses the controversy regarding surveillance and the timing of treatment for recurrent disease.
RECENT FINDINGS: Routine physical examination has a limited role in the detection of recurrent ovarian cancer. PET/computed tomography (CT) has been shown to be useful in detecting small volume disease not apparent on traditional imaging in patients with suspected recurrence based on symptoms and/or rising CA125. The results of PET/CT can alter treatment plans and have particular use in guiding site-directed therapy. The benefits of early detection and systemic treatment of recurrence are now in doubt following the presentation of the MRC/EORTC CA125 surveillance trial. The impact on survival of secondary cytoreductive surgery requires more investigation.
SUMMARY: Uncertainties remain in the surveillance and timing of treatment for relapsed disease. Patients should be informed of these uncertainties and become involved in decisions regarding their follow-up.

AJR Am J Roentgenol. 2010 Role of PET/CT in Ovarian Cancer

Abstract OBJECTIVE: The purpose of this article is to review the role of FDG PET/CT in ovarian cancer, which is the leading cause of death among gynecologic cancers. CONCLUSION: FDG PET/CT can significantly modify the assessment of the extent of primary and recurrent ovarian cancer and, hence, often alters patient management substantially. FDG PET/CT has thus become a critical tool for the preoperative evaluation of women with primary ovarian cancer and for postoperative follow-up assessment for evidence of recurrence in these patients.

Associations Among Cancer Survivorship Discussions, Patient and Physician Expectations, and Receipt of Follow-Up Care - JCO abstract

Note: abstract - 1)  pay-per-view/subscription journal; 2) selected key points:  total study # of patients= 431; breast cancer responses = 52%; gyn cancers = 4%; study did not break down differing gyn cancers; caucasian =94%