title: Evaluation of ovarian cancer remission markers HE4, MMP7 and Mesothelin by comparison to the established marker CA125.
abstract: OBJECTIVE
  Evaluate and compare the effectiveness of CA125, HE4, Mesothelin and MMP7 marker levels to monitor ovarian cancer patients after surgery and chemotherapy. Evaluate the lead time of a rise of marker levels before recurrence.
  
  
  METHODS
  The study consists of 23 patients with advanced stage ovarian/fallopian tube cancer. Blood was drawn after front line surgery and chemotherapy treatment and at 3 month intervals thereafter. One patient had chemoresistant disease, two patients remained in remission and 20 patients had recurring disease and were used for marker evaluation.
  
  
  RESULTS
  In five patients HE4 was the only marker to elevate before recurrence with a lead time of up to 4½ months including one patient who did not have a CA125 response at all. In a further two patients, HE4 increased before CA125 did. In four of these seven patients, HE4 levels were consistently at or above threshold during remission when both CA125 and imaging results were negative. MMP7 elevated before recurrence in one patient who was negative for the other markers. Mesothelin elevated in two patients who were also positive for CA125 and HE4.
  
  
  CONCLUSIONS
  HE4 can predict ovarian cancer recurrence earlier than CA125 and it can be elevated in patients that do not express CA125 at sufficient levels to make a clinical decision. MMP7 and Mesothelin have lower potential as markers for ovarian cancer recurrence to complement CA125. A failure of HE4 levels to normalize at completion of standard therapy may indicate a poor prognosis.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. mschumme@fhcrc.org
authors.forename: Michèl
authors.initials: M
authors.lastname: Schummer
authors.forename: Charles
authors.initials: C
authors.lastname: Drescher
authors.forename: Robin
authors.initials: R
authors.lastname: Forrest
authors.forename: Shirley
authors.initials: S
authors.lastname: Gough
authors.forename: Jason
authors.initials: J
authors.lastname: Thorpe
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Hellström
authors.forename: Karl Erik
authors.initials: KE
authors.lastname: Hellström
authors.forename: Nicole
authors.initials: N
authors.lastname: Urban
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D058851:GPI-Linked Proteins / Q000097:blood*; D006801:Humans; D020783:Matrix Metalloproteinase 7 / Q000097:blood*; D008565:Membrane Proteins / Q000097:blood*; D000090204:Mesothelin; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D011506:Proteins / Q000378:metabolism*; D012008:Recurrence; D000081102:WAP Four-Disulfide Core Domain Protein 2
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D058851:GPI-Linked Proteins; C451759:MUC16 protein, human; D008565:Membrane Proteins; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human; C060932:MMP7 protein, human; D020783:Matrix Metalloproteinase 7; D000090204:Mesothelin