Recurrent Ovarian Cancer: When to Treat and How to Assess
Recurrent ovarian cancer is rarely curable. The primary goal in “platinum-sensitive” (PS) relapse is to prolong survival, whereas palliation is often the objective in managing “platinum-resistant” (PR) disease. Whether or not to monitor patients in complete clinical remission with CA125 in order to detect recurrence should be discussed with each patient as she enters into follow-up with a review of the available literature including the strengths and limitations of the one randomized trial. Some patients will choose to be monitored with CA125 to permit optimal planning of their lives following asymptomatic recurrence, to facilitate timely secondary cytoreduction, and to provide sufficient time to evaluate conventional and novel therapy. Others will prefer not to be monitored in the absence of evidence that earlier detection prolongs survival. When CA125 is used as an endpoint in randomized clinical trials, it is important to monitor biomarker levels at similar intervals on all arms. Aside from research protocols, physicians must be aware that frequent monitoring of CA125 will reduce progression-free survival (PFS) and may result in patients being judged “platinum resistant” when they still might benefit from the drug. If CA25 is used to monitor patients during maintenance therapy with antiangiogenic agents, disease recurrence should not be based on the biomarker alone, but should be confirmed by imaging before treatment is discontinued.
KeywordsOverall Survival Ovarian Cancer Ovarian Cancer Patient Cytoreductive Surgery Recurrent Ovarian Cancer
This work was supported by funds from the M.D. Anderson SPORE in Ovarian Cancer NCI P50 CA83639, the M.D. Anderson CCSG NCI P30 CA16672, the National Foundation for Cancer Research, and The Zarrow Foundation and Stuart and Gaye Lynn Zarrow. IR was supported by the first Grupo Español de Investigación en Cáncer de Ovario (GEICO)-Jan Vermorken grant.
Each author contributed equally to this chapter.
Conflicts of Interest
Robert C Bast receives royalties for the discovery of CA125 from Fujirebio Diagnostics Inc. and serves on scientific advisory boards for Vermillion.
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