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The Lancet Oncology

Tuesday, June 23, 2009

No survival benefit with treatment based on rising CA125 blood levels in Recurrent Ovarian Cancer

There appears to be no survival advantage to treating ovarian cancer relapse based on rising CA125 levels, compared with waiting for symptoms. This is the conclusion from a study that was featured during the 45th Annual Meeting of the American Society of Clinical Oncology (ASCO), the world’s leading professional organization representing physicians who care for people with cancer.

A team of researchers, lead by Gordon J. Rustin, MD professor of oncology at Mount Vernon Cancer Center, Hertfordshire, United Kingdom, reported that starting treatment immediately for an ovarian cancer relapse based on CA125 protein levels found in the blood does not improve overall survival, compared with delaying treatment until symptoms arise. The findings should allow women to avoid the anxiety and cost associated with frequent blood testing and the toxicity of early treatment.

“Women who’ve completed ovarian cancer treatment often worry about a relapse, and they undergo frequent blood tests for CA125 in the hope of catching it early,” Rustin said.

CA125 often rises several months before women with OC have symptoms or clinical signs of relapse. This study (MRC OV05/EORTC 55955 trials), conducted by the MRC/NCRI and EORTC Gynae Cancer Intergroups, was designed to determine whether there were benefits from early treatment based on a confirmed elevation of CA125 levels versus delaying treatment until clinically indicated.

“We thought that delaying chemotherapy might make overall quality of life worse, due to the symptoms of ovarian cancer, but this was not seen in women on this trial. Since there is no benefit from early chemotherapy, patients may choose to avoid the inconvenience and anxiety associated with frequent retesting for CA125 levels as well as unnecessary early initiation of treatment for relapse,” Rustin explains.

CA125 is a marker of growth for several cancers, including ovarian cancer, and is measured by a blood test. Women who have undergone treatment for ovarian cancer may have their CA125 levels tested as often as every three months for several years after initial treatment.

In this study, investigators compared overall survival between 265 women with ovarian cancer in remission after initial chemotherapy who began second-line chemotherapy after experiencing a rise in CA125, and 264 women with rising CA125 whose treatment was delayed until symptoms of relapse appeared (such as pelvic pain or bloating).

Even though the early treatment group started second-line chemotherapy an average five months before the delayed treatment group, overall survival was the same between both groups: 41 months since completion of first-line chemotherapy.

The researchers added that this trial provides important information that will help women make informed choices about their follow-up and treatment. They can be reassured that treatment can safely be delayed until symptoms develop.

ASCO 2009 abstract:

For more information, read these PubMed abstracts:

Help your patients understand:

  • For consumer-oriented information about the studies in this article, please refer your patients to ASCO’s patient website.

Photo and illustration courtesy of the American Society of Clinical Oncology.

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