Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy

Rodriguez, Noah; Rauh‐Hain, J. Alejandro; Shoni, Melina; Berkowitz, Ross S.; Muto, Michael G.; Feltmate, Colleen M.; Schorge, John O.; Carmen, Marcela G. del; Matulonis, Ursula A.; Horowitz, Neil S.

doi:10.1016/j.ygyno.2012.02.006

Cited by 62 publications

(64 citation statements)

References 25 publications

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“…Multivariable analysis for predictors of OS and PFS The relation between preoperative CA-125 and extent of surgical cytoreduction using 100 and 20 as cutoff used as a proxy for tumor response and could correlate with patient outcome.The rate of optimal cytoreduction in our study (87%) is slightly lower than those reported by Rodriguez et al18 and Tate et al 16 (both 96%) but higher than that reported by Le at al 17 (54%) and Furukawa et al 19 (61.3%). Possible explanations include different criteria for the selection of patients receiving NAC (vs primary debulking surgery), the decision to perform IDS after NAC, and different surgical aggressiveness.…”

contrasting

confidence: 70%

“…18,19 Specifically, Rodriguez et al 18 determined that a CA-125 level less than 100 U/mL could predict complete interval cytoreduction. In their cohort, neither absolute nor percent change in CA-125 level predicted complete cytoreduction.…”

Section: Discussionmentioning

confidence: 99%

“…The secondary objective was to determine whether the percent reduction of CA-125 correlated with patient outcome (PFS and OS). Finally, we investigated whether a preoperative CA-125 level less than 100 U/mL or less than 20 U/mL, as cited in previous work, 18,19 correlated with these same end points.…”

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confidence: 82%

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The Impact of Percent Reduction in CA-125 Levels on Prediction of the Extent of Interval Cytoreduction and Outcome in Patients With Advanced-Stage Cancer of Müllerian Origin Treated With Neoadjuvant Chemotherapy

Mahdi¹,

Maurer²,

Nutter

et al. 2015

International Journal of Gynecological Cancer

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confidence: 70%

Section: Discussionmentioning

confidence: 99%

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The Impact of Percent Reduction in CA-125 Levels on Prediction of the Extent of Interval Cytoreduction and Outcome in Patients With Advanced-Stage Cancer of Müllerian Origin Treated With Neoadjuvant Chemotherapy

Mahdi¹,

Maurer²,

Nutter

et al. 2015

International Journal of Gynecological Cancer

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“…Additionally, we have shown that the mean CA 125 level prior to IDS is strongly associated with OS, as is particularly illustrated by our comparison of the high-CA 125 (>100 U/mL) and low-CA 125 (<35 U/mL) groups. The CA 125 cut-off value used by Rodriguez et al 16 was substantially greater than that of the present study because Rodriguez et al 16 included a median of 3 courses of NACT, whereas our study included a median of 6 courses. Vasudev et al 18 reported that the regression rate of serum CA 125 levels during NACT had both prognostic and predictive value.…”

Section: Discussionmentioning

confidence: 57%

“…However, some researchers have investigated correlations between the achievement of cytoreduction and changes in serum CA 125 levels. Rodriguez et al 16 evaluated the relation- ship between mean serum CA 125 levels and surgical outcomes in a study of 103 patients with Stage IIIC/IV EOC who were treated with platinum-based NACT followed by IDS. The mean serum CA 125 levels prior to IDS differed significantly between the complete/optimal and suboptimal surgery groups (92 vs. 233 U/mL; p< 0.01).…”

Section: Discussionmentioning

confidence: 99%

Serum CA 125 Level after Neoadjuvant Chemotherapy is Predictive of Prognosis and Debulking Surgery Outcomes in Advanced Epithelial Ovarian Cancer

et al. 2017

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Impact of Chemotherapy Dosing on Ovarian Cancer Survival According to Body Mass Index

Bandera

Lee

Rodrı́guez-Rodrı́guez

et al. 2015

JAMA Oncol

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IMPORTANCE Optimal chemotherapy dosing in obese patients remains uncertain, with variation in practice. Dose reduction strategies are often used to avoid chemotoxicity, but recent American Society of Clinical Oncology guidelines recommend full dose. OBJECTIVE To evaluate the impact of body mass index (BMI) on chemotherapy dosing and of dose reduction on ovarian cancer survival. DESIGN, SETTING, AND PARTICIPANTS Cohort study in Kaiser Permanente Northern California (KPNC) health care setting of patients with primary invasive epithelial ovarian cancers diagnosed from January 2000 through March 2013. Analyses focused on 806 patients receiving adjuvant first-line therapy of carboplatin and paclitaxel with curative intent. MAIN OUTCOMES AND MEASURES Overall and ovarian cancer–specific mortality. Deaths were identified through the KPNC Mortality Linkage System, with median follow-up of 52.5 months. Hazard ratios (HRs) and 95% CIs were estimated from proportional hazards regression, accounting for prognostic variables including age at diagnosis, race, stage, grade, histologic type, chemotoxic effects, comorbidities, cancer antigen 125 levels, and BMI at diagnosis. RESULTS The strongest predictor of dose reduction was a high BMI. Compared with normal-weight women, obese class III women received 38% and 45% lower doses in milligrams per kilogram of body weight of paclitaxel and carboplatin, respectively (P < .001 for each agent). They also received lower relative dose intensity (RDI) for each agent and the combined regimen, calculated as average RDI (ARDI). Mean ARDI was 73.7% for obese class III women and 88.2% for normal-weight women (P < .001). Lower ARDI (<70%) was associated with worse overall (HR, 1.62 [95% CI, 1.10–2.37]) and ovarian cancer–specific survival (HR, 1.69 [95% CI, 1.12–2.55]). Women who were obese at diagnosis appeared to have better survival. In multivariable-adjusted analyses considering joint effects by BMI and ARDI, compared with women with normal weight and no dose reduction, normal-weight women with dose reduction (ARDI < 85%) experienced worse survival (HR, 1.50 [95% CI, 1.02–2.21]). For each BMI category, those with ARDI less than 85% had worse survival than those without dose reduction. The improved survival among obese women was no longer apparent with dose reduction. CONCLUSIONS AND RELEVANCE Lower RDI was an independent predictor of ovarian cancer mortality. This finding was strongest among normal-weight women but seen at all levels of BMI. Our results suggest that body size should not be a major factor influencing dose reduction decisions in women with ovarian cancer.

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Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy

Cited by 62 publications

References 25 publications

The Impact of Percent Reduction in CA-125 Levels on Prediction of the Extent of Interval Cytoreduction and Outcome in Patients With Advanced-Stage Cancer of Müllerian Origin Treated With Neoadjuvant Chemotherapy

The Impact of Percent Reduction in CA-125 Levels on Prediction of the Extent of Interval Cytoreduction and Outcome in Patients With Advanced-Stage Cancer of Müllerian Origin Treated With Neoadjuvant Chemotherapy

Serum CA 125 Level after Neoadjuvant Chemotherapy is Predictive of Prognosis and Debulking Surgery Outcomes in Advanced Epithelial Ovarian Cancer

Impact of Chemotherapy Dosing on Ovarian Cancer Survival According to Body Mass Index

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