CA-125 can be part of the tumour evaluation criteria in ovarian cancer trials: experience of the GCIG CALYPSO trial

Abstract

Background:CA-125 as a tumour progression criterion in relapsing ovarian cancer (ROC) trials remains controversial. CALYPSO is a large randomised trial incorporating CA-125 (GCIG criteria) and symptomatic deterioration in addition to Response Evaluation Criteria in Solid Tumours (RECIST) criteria (radiological) to determine progression.Methods:In all, 976 patients with platinum-sensitive ROC were randomised to carboplatin–paclitaxel (C-P) or carboplatin-pegylated liposomal doxorubicin (C-PLD). CT-scan and CA-125 were performed every 3 months until progression.Results:In all, 832 patients (85%) progressed, with 60% experiencing a first radiological progression, 10% symptomatic progression, and 28% CA-125 progression without evidence of radiological or symptomatic progression. The benefit of C-PLD vs C-P in progression-free survival was not influenced by type of first progression (hazard ratio 0.85 (95% confidence interval (CI): 0.66–1.10) and 0.84 (95% CI: 0.72–0.98) for CA-125 and RECIST, respectively). In patients with CA-125 first progression who subsequently progressed radiologically, a delay of 2.3 months was observed between the two progression types. After CA-125 first progression, median time to new treatment was 2.0 months. In all, 81%of the patients with CA-125 or radiological first progression and 60% with symptomatic first progression received subsequent treatment.Conclusion:CA-125 and radiological tests performed similarly in determining progression with C-PLD or C-P. Additional follow-up with CA-125 measurements was not associated with overtreatment.

The combination of intravenous bevacizumab and metronomic oral cyclophosphamide is an effective regimen for platinum-resistant recurrent ovarian cancer

“…We used CA-125 levels to evaluate for disease response when imaging was not available to evaluate disease by RECIST criteria. CA-125 levels and disease status by RECIST criteria have been shown to correlate well [17-19]. However, CA-125 levels may show a CR (be in normal range) when disease persists on imaging, thus the use of CA-125 levels may have resulted in an over estimation of our CRs [12].…”

A longitudinal analysis of CA125 glycoforms in the monitoring and follow up of high grade serous ovarian cancer

“…In large randomized clinical trials, CA125 has been reported to be both supportive to [34] and in poor concordance with [35] radiologic response evaluation. The studies advising against routine measurement of CA125 in HGSC follow up have been made in an era before novel targeted therapies [36].…”

Cost effectiveness analysis of plasma genotyping versus tumor genotyping in detection of advanced non-small-cell lung cancer with epidermal growth factor receptor and T790M mutation under the Brazilian private healthcare system perspective

“…Detection of biological markers in the blood stream is not a new concept. For example, for many years the carcinoembryonic antigen (CEA), the prostate-specific antigen (PSA) or the Ca-125, among others, were used to assess the treatment response (Friedrich, 2017), defining the conduct subsequently taken, whether the clinical follow-up, maintenance of the treatment initially applied or even the search for an alternative treatment given the lack of response, which was observed with the marker increase (Murray et al, 2015;Stremitzer et al, 2015;Alexandre et al, 2012). The plasma genotyping has the potential to bring a higher number of information, not only about the decision of whether to treat or not treat, but also about how to treat or how to optimize the treatment response.…”