Prognostic value of CA 125 and neopterin in women with ovarian cancer undergoing second-look laparotomy

Between 1986 and 1990 50 patients with ovarian cancer were submitted to a procedure which we called REGAJ - resection guided by antibodies. Using the radiolabeled murine monoclonal antibody OC 125, microscopic ovarian tumors producing CA 125 were detected during second-look surgery by a hand-held probe. Retrospective analysis after 10 years revealed that this procedure resulted in the cure of 4 of 11 patients, who would otherwise have been considered tumor free during second-look surgery and not further treated. Previous problems associated with the method can now be solved so that the clinical value of the procedure should be reconsidered.

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OVX1 radioimmunoassay complements CA-125 for predicting the presence of residual ovarian carcinoma at second-look surgical surveillance procedures.

Journal of Clinical Oncology ◽

10.1200/jco.1993.11.8.1506 ◽

1993 ◽

Vol 11 (8) ◽

pp. 1506-1510 ◽

Cited By ~ 34

Author(s):

F J Xu ◽

Y H Yu ◽

L Daly ◽

K DeSombre ◽

L Anselmino ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Patients ◽

Elevated Serum ◽

Ca 125 ◽

Serum Samples ◽

Persistent Disease ◽

Second Look ◽

Normal Individuals ◽

Positive Results ◽

Apparently Healthy

PURPOSE At second-look surgical surveillance procedures, normal CA-125 levels can be associated with persistent disease in 50% to 60% of patients. A novel radioimmunoassay (RIA) has been evaluated for the ability to identify patients with persistent disease who have normal levels of CA-125. MATERIALS AND METHODS The OVX1 double-determinant assay used a murine monoclonal antibody to detect an epitope on a high-molecular weight mucin-like glycoprotein. RESULTS Apparently healthy individuals had serum OVX1 levels of 2.23 +/- 2.48 U/mL (mean +/- SD). Elevated serum OVX1 levels (> 7.2 U/mL) were found in 5% of 184 normal individuals and in 70% of 93 epithelial ovarian cancer patients with clinically evident disease. Among sera from these ovarian cancer patients, OVX1 was elevated in 68% of 76 samples with CA-125 levels more than 35 U/mL and in 76% of 17 samples with CA-125 levels less than 35 U/mL. In serum samples obtained at the time of positive second-look laparotomy, 59% of 41 patients with CA-125 levels less than 35 U/mL had elevated OVX1 antigen levels, whereas 41% of 22 patients with CA-125 levels more than 35 U/mL had elevated serum OVX1 levels. In patients with negative second-look laparotomies, false-positive results were eliminated by increasing the threshold of OVX1 to 10.5 U/mL. At this level, 32% of 41 patients with positive second-look operations had an elevated OVX1 level, despite a normal CA-125 level. When used in combination, CA-125 (> 35 U/mL) and OVX1 (> 10.5 U/mL) detected persistent disease in 56% of 63 patients with positive surveillance procedures, compared with 35% when CA-125 was used alone (P < .05). CONCLUSION An elevated OVX1 level can alert oncologists to the possibility that ovarian cancer has persisted, despite the return of CA-125 to a normal range.

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Is there a CA-125 level that predicts negative second look surgery (SLS) in patients with advanced epithelail ovarian cancer (EOC)?

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.15042 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 15042-15042

Author(s):

S. Sharma ◽

P. Singhal ◽

K. Odunsi ◽

S. Lele

Keyword(s):

Ovarian Cancer ◽

Disease Free Survival ◽

Disease Status ◽

Primary Treatment ◽

Ca 125 ◽

Primary Therapy ◽

Second Look ◽

Kaplan Meier ◽

Response To Chemotherapy ◽

Disease Free

15042 Background: The value of second look surgery (SLS) in advanced epithelial ovarian cancer (EOC) has been has been questioned because performing this procedure has not been associated with a clear survival advantage.However, SLS continues to be the most accurate means of documenting the response to chemotherapy, and therfore still used in investigational protocols. The primary purpose of this study was to assess the levels of CA 125 after treatment, that could predict absence of disease at SLS. Methods: Between 1998 and 2003, 98 stage III EOC patients who underwent optimal cytoreductive surgery, completed 6 cycles of platinum/paclitaxel chemotherapy, and were NED (no evidence of disease: normal CA 125, normal physical and radiological examination) were included in this study. SLS was performed at 6–8 weeks from completion of primary therapy. Patients with disease present at SLS were considered to have persistent disease and received second line chemotherapy. Patient demographics, surgical and chemotherapy treatments, and CA 125 levels prior to start and at completion of primary treatment were collected retrospectively. Survival was estimated by the Kaplan-Meier method. Results: Forty seven out of 98 (48%) of optimally debulked patients who were NED at completion of primary therapy underwent SLS. Twenty-five out of 47 patients (53%) had evidence of disease at SLS and 22 out of 47 patients (47%) were NED at SLS. The median disease free survival was 42 months (95% CI 16, 81) in patients with negative SLS compared with 17 months (95% CI 9, 45) in patients who did not undergo SLS (p = 0.03). Estimated 5-year survival in patients with negative SLS was 90% compared to 50% in patients who did not undergo SLS (p = 0.05). CA 125 levels of ≤ 10 after completion of primary therapy was predictive of negative SLS (p < 0.05). Conclusions: SLS evaluation of disease status appears to be a more accurate than standard clinical evaluation in patients who are NED at completion of their primary therapy. Negative SLS also appears to be a predictor of improved disease free and overall survival. Furthermore, CA 125 ≤ 10 is predictive of negative SLS in patients who are NED after completion of primary therapy. No significant financial relationships to disclose.

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