CA125 Level Association With Chemotherapy Toxicity and Functional Status in Older Women With Ovarian Cancer

Abstract

Objective Older women with ovarian cancer have increased cancer-related mortality and chemotherapy toxicity. CA125 is a sensitive biomarker for tumor burden. The study evaluates the association between CA125, geriatric assessment (GA), and treatment toxicity. Methods This is a secondary subset analysis of patients age ≥65 with ovarian cancer accrued to a multicenter prospective study that developed a predictive toxicity score for older adults with cancer. Clinical and geriatric covariates included sociodemographics, GA (comorbidity, social support, functional, nutritional, psychological, cognitive status), treatment, and labs. Utilizing bivariate analyses, we determined the association of abnormal CA125 (≥35 U/mL) with baseline GA, grade 3–5 toxicity (CTCAE v.3), dose adjustments, and hospitalization. Logistic regression analysis was used to check for potential confounder for association between CA125 and chemotherapy toxicity. Results Fifty-one (10%) of 500 patients accrued to the primary study had a diagnosis of ovarian (92%), peritoneal (4%), or fallopian tube (4%) cancer. Median age was 72 (range, 65–86). Forty-six patients (90%) had stage III–IV disease. Twenty-three patients (45%) received first-line chemotherapy, and 34 (67%) received platinum-doublet therapy. Thirty-six (71%) had an abnormal CA125. Grade 3–5 toxicity occurred in 19 patients (37%). Abnormal CA125 was associated with assistance with instrumental activities of daily living (IADL) (p<0.05), lower performance status (p=0.05), grade 3–5 toxicity (p=0.03), non-heme toxicity (p=0.04), and dose reductions (p=0.01). No association between CA125 level and total toxicity score was observed. Conclusions Among older women with ovarian cancer, abnormal CA125 was associated with poor pre-treatment functional status and an increased probability of chemotherapy toxicity and dose reduction.

Lessons Learned from Arti—Collaborating to Improve Care: the Past, Present, and Future of the Cancer and Aging Research Group

“…Arti was extremely generous with sharing of data and strongly encouraged others to utilize data from her studies to help foster their own careers. Data from the CARG toxicity tool studies were utilized to understand many other issues for older adults with cancer, including prevalence of dose reductions, prediction of falls, use of monoclonal antibodies, and relationships between biomarkers and outcomes in this population …”

“…Data from the CARG toxicity tool studies were utilized to understand many other issues for older adults with cancer, including prevalence of dose reductions, prediction of falls, use of monoclonal antibodies, and relationships between biomarkers and outcomes in this population. [27][28][29][30] Following her death, we have assumed the co-leadership role of CARG to continuing fostering and advancing its work in geriatric oncology, principally by leading the twicemonthly calls of the community. In short, CARG is the recognized center of the geriatric oncology community, and we are helping to bridge our community into the future without Arti by our side.…”

Epithelial Ovarian Cancer in Older Women: Defining the Best Management Approach

“…Abnor-mal CA125 was associated with assistance with IADL, low PS, chemotherapy toxicity, and dose reductions. 68 The French GINECO group has developed a GVS from a series of up-front trials in older women with ovarian cancer. The GVS includes the high-risk variables of low albumin (less than 35 g/L), low ADL score (less than 6), low IADL score (less than 25), lymphopenia (less than 1G/L), and a high hospital anxiety and depression (HADS) score (greater than 14).…”

Characteristics and survival of ovarian cancer patients treated with neoadjuvant chemotherapy but not undergoing interval debulking surgery

“…As a result, multiple clinical factors and their associations with outcomes in patients with ovarian cancer who received NACT have been studied to improve patient selection. Some have suggested that age [15], comorbidities [15], functional status [16], cancer antigen 125 (CA-125) level [1718], and type of chemotherapy and number of cycles [1920] may influence surgical morbidity and survival. However, studies are conflicting [21], and although many predictive models [2223] have been proposed, no one has been widely adopted.…”