Evaluation of various kinetic parameters of CA-125 in patients with advanced-stage ovarian cancer undergoing neoadjuvant chemotherapy

Abstract

Various kinetic parameters of serum CA-125 have been reported to have better correlation with outcomes for patients treated with neoadjuvant chemotherapy (NAC). This study aimed to compare the available kinetic parameters of serum CA-125 in an external cohort of advanced-stage ovarian cancer. Using the cancer registry databases from the Yonsei Cancer Hospital, we retrospectively reviewed 210 patients with advanced-stage ovarian cancer, treated with NAC followed by interval debulking surgery. We compared area under the receiver-operating characteristics curves (AUCs), false negative rate, and negative predictive value (NPV) using 10 different models for optimal cytoreduction and platinum resistance. In addition, we compared incremental AUC for progression-free survival (PFS) and overall survival (OS). No gross residual tumor was observed in 37.0% and residual tumors <1 cm in 82.2% of patients. No model using CA-125 kinetic parameters had an AUC higher than >0.6 for predicting optimal cytoreduction. After adjusting for age, BMI, disease stage, and histologic subtypes, all models had an AUC >0.70 for predicting platinum resistance. However, no model had a high enough NPV (highest value = 82.0%) to avoid chemotherapy futility. For survival outcomes, no model had an incremental AUC >0.70 for predicting either PFS or OS. None of the proposed serum CA-125 kinetic parameters showed high accuracy in predicting optimal cytoreduction, platinum resistance, or survival in patients receiving NAC. For advanced-stage ovarian cancer treated with NAC, there is a need to discover reliable biomarkers to better stratify patient response groups for optimal treatment decision-making.

The role of the tumor primary chemosensitivity relative to the success of the medical-surgical management in patients with advanced ovarian carcinomas

“…The Gynecologic Cancer Intergroup (GCIG) defined the CA-125 response as a 50% reduction in CA-125 levels maintained for at least 28 days, in patients treated for recurrent diseases [49,50]. Different studies, including a recent analysis of the ICON-8 phase III trial dataset showed that this criterion was inadequate for assessing the efficacy of the neoadjuvant chemotherapy and predicting the benefit from IDS [48,51,52].…”

CA-125 ELIMination Rate Constant K (KELIM) Is a Marker of Chemosensitivity in Patients with Ovarian Cancer: Results from the Phase II CHIVA Trial

“…The predictive values of CA-125 decline percentages during treatments were extensively investigated, with inconsistent outcomes (3)(4)(5)(6). The Gynecologic Cancer Intergroup (GCIG) defined the CA-125 response as a 50% reduction in CA-125 levels maintained for at least 28 days, in patients treated for recurrent diseases (7).…”

Role of Neoadjuvant Chemotherapy in Ovarian Serous Cancer Followed by Debulking

“…CA-125 reduction may be used to predict the chemotherapy response in the neoadjuvant environment. Patients who do not respond to CA-125 also do not experience IDS and have a poor prognosis [1][2][3][4][5][6].…”

“…The only routine biomarker used to assess the status of the disease and monitor the success of chemotherapy in patients with epithelial ovarian cancer is cancer antigen-125 (CA-125). The value of CA-125 is expected to correlate with neoadjuvant chemotherapy (NACT) response in the neoadjuvant situation, where the effects of surgery are absent [ 4 - 6 ]. We present a case of serous papillary cystadenocarcinoma of the ovary in a 50-year-old patient and its treatment by NACT and debulking surgery [ 7 , 8 ].…”