Predictive value of serum CA125 following optimal cytoreductive surgery during weekly cisplatin induction therapy for advanced ovarian cancer.
One hundred seventy-one patients with epithelial ovarian cancer were treated on a prospective protocol of weekly cisplatin induction (1 mg/kg weekly for four courses) followed by monthly cisplatin (50 mg/m2), Adriamycin (50 mg/m2), and cyclophosphamide (750 mg/m2). Seventy-five patients with FIGO stage III or IV disease who underwent optimal cytoreductive surgery (<2 cm residual disease) were treated on this protocol and had weekly as well as monthly serum CA125 levels measured. A retrospective analysis was performed in order to determine if a > or = 50% fall in elevated serum CA125 levels during weekly cisplatin induction therapy would be predictive of findings at second look operation, normalization of serum CA125 levels (< 35 u/ml) immediately prior to the third course of multiagent chemotherapy, and to determine the impact of such a decline on median progression-free interval. Positive predictive values for this parameter with respect to findings at second look operation ranged between 38% and 50% (P > 0.05). Positive predictive values for this parameter with respect to normalization of serum CA125 levels immediately prior to the third course of multiagent chemotherapy ranged between 64.2% and 89.6% (P > 0.05). Logistic regression analysis demonstrated that a > or = 50% fall observed in CA125 levels during four weekly courses of chemotherapy served as an independent predictor of normalization of serum CA125 levels (<35 u/ml) following two courses of multiagent chemotherapy (P = 0.009) and improved median progression-free interval (P = 0.04). Eighteen patients demonstrated a rise in serum CA125 levels during weekly induction cisplatin chemotherapy. Only one of these patients (5.5%) demonstrated a surgical complete response at the end of standard therapy.
Hempling
R E
RE
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263.
Piver
M S
MS
Natarajan
N
N
Baker
T R
TR
Thompson
J M
JM
Hicks
M L
ML
Mettlin
C J
CJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D010052:Ovariectomy / Q000706:statistics & numerical data; D011182:Postoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
D015295:Antigens, Tumor-Associated, Carbohydrate; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin