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

Matsuhashi, Tomohiro; Takeshita, Toshiyuki; Yamamoto, Akihito; Kawase, Rieko; Yamada, Takashi; Kurose, Kouichi; Doi, Daisuke; Konnai, Katsuyuki; Onose, Ryo; Kato, Hiroyuki

doi:10.1272/jnms.84.170

Cited by 12 publications

(19 citation statements)

References 20 publications

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“…The results are consistent with previous studies, where 17.8–57% of patients were reported to have a pre-IDS CA125 level <35 U/mL,19,22,24–26 and 31.3–53.3% of patients had a pre-IDS CA125 level <20 U/mL 21,23. In addition, the median percent reduction in CA125 of our cohort was 94.7% (range, 86.3–99.4), which is consistent with Mahdi’s study, where the reported median percentage was 94.5% (range, 33–97.7).21 Of note, most patients in the abovementioned studies underwent more than three cycles of NACT,19,21,24,25 while all patients in our study received exactly three cycles of NACT. Considering that each additional cycle of NACT between 3 and 6 cycles is associated with a 4-month decrease in OS,27 we believe that using HIPEC in a neoadjuvant setting could allow NACT to more efficiently decrease the level of CA125 and thus enhance the therapeutic effect of NACT.…”

Section: Discussionsupporting

confidence: 93%

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<p>Feasibility and safety of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in patients with advanced stage ovarian cancer: a single-center experience</p>

Gao

Huang

Wang

et al. 2019

CMAR

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For patients with advanced ovarian cancer, neoadjuvant chemotherapy (NACT) can significantly increase the rate of optimal cytoreduction. However, this does not translate into a survival benefit. The aim of this study was to investigate the feasibility and effect of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy (NLHIPEC). Methods: Between March 2016 and February 2018, 14 patients with advanced ovarian cancer who were not candidates for optimal cytoreduction via primary debulking surgery (PDS) received NLHIPEC. Their clinical data were retrospectively analyzed. Results: No patients experienced intraoperative complications during NLHIPEC. Grade 3 adverse events (AEs) were noted in two (14.3%) patients, and all patients received planned NACT without dose delay or dose reduction. Following NACT, CA125 levels <35 U/mL and <20 U/mL were observed in six (42.9%) patients and five (35.7%) patients, respectively. All patients underwent interval debulking surgery (IDS) after the last NACT cycle. After IDS, R0 resection was achieved in 10 (71.4%) patients without intraoperative injury, and one (7.1%) patient developed a grade 3 AE. During a median follow-up time of 16 months, no patients died of disease, and the median progression-free survival (PFS) was not achieved. Progression was noted in six (42.9%) patients (range, 9-21 months). Conclusions: NLHIPEC appears to be a feasible option for ovarian cancer patients who have a low likelihood of achieving optimal cytoreduction during PDS.

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Section: Discussionsupporting

confidence: 93%

“…Following NACT, both patients with a CA125 level <35 U/mL and those with a CA125 level <20 U/mL were reported to have improved survival outcomes 19–23. Therefore, we used these measurements as cutoff values.…”

Section: Discussionmentioning

confidence: 99%

<p>Feasibility and safety of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in patients with advanced stage ovarian cancer: a single-center experience</p>

Gao

Huang

Wang

et al. 2019

CMAR

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“…[ 9 , 10 ] A high percentage of patients with EOC suffer relapse and cancer metastasis within 2 years of receiving surgical treatment combined with chemotherapy. [ 11 ] Therefore, studying the expression of genes associated with drug-resistant EOC and their involvement in platinum resistance may have important clinical significance for optimizing EOC chemotherapy regimens and judging the drug resistance of tumor types.…”

Section: Discussionmentioning

confidence: 99%

Expression of resistance gene and prognosis of chemotherapy in primary epithelial ovarian cancer

Yang

Gao²,

Chen³

et al. 2018

Medicine

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The sensitivity of tumor cells to chemotherapy drugs may become attenuated accounts for various reasons. Reduced drug sensitivity may cause the failure of chemotherapy and affect the prognosis of patients with cancer. This study investigates the relationship between the expression levels of lung resistance protein (LRP) and placental glutathione S-transferase-P1 (GSTP1), the resistance of primary epithelial ovarian cancer (PEOC) to chemotherapy, and the prognosis of patients with platinum drug-resistant PEOC.Quantitative PCR (QT-PCR) was used to detect the mRNA level of the resistance genes LRP, GSTP1 in all tissue and cell lines.The expression levels of resistance gene (LRP, GSTP1) in PEOC were the highest, followed by borderline adenoma tissues, and the lowest levels found in benign tumor tissues, the difference of genes expression between different tissues was statistically significant; the difference between the expression rates and relative expression level of drug resistance genes was statistically significant in platinum sensitive group compare with the platinum resistant group. The difference between resistant gene negative-expression and positive-expression of chemotherapy efficiency, disease free survival time, and recurrence time were statistically significant. The resistant genes expression in the PEOC patients of the negative-group survival curves was higher than that in the positive group. With ascites non-cellular component (ANCC) stimulated SKOV3 cells, the cell proliferation inhibition rate (CPIR) increased, and with ANCC stimulated SKOV3/DDP, the expression of LRP and GSTP1 also increased.ANCC may promote the expression of drug resistance genes, and the expression of genes may predict the poorly prognosis of epithelial ovarian cancer.

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“…Another study, however, reported that a preoperative serum CA-125 level of ≤30 U/mL was a significant predictor of optimal cytoreduction [33]. Some studies found that a post-NACT serum CA-125 level of <35 U/mL was associated with better PFS and OS [80,81] and higher chances of optimal cytoreduction [81] and was an independent prognostic factor for sensitivity to platinum therapy [80]. A post-NACT serum CA-125 level of >100 U/mL was associated with worse PFS and OS in patients with stage III or IV ovarian cancer [56].…”

Section: Models Based On Circulating Molecular Markersmentioning

confidence: 99%

Emerging Trends in Neoadjuvant Chemotherapy for Ovarian Cancer

Patel

Iyer

Matsuzaki

et al. 2021

Cancers

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Epithelial ovarian cancer remains a leading cause of death amongst all gynecologic cancers despite advances in surgical and medical therapy. Historically, patients with ovarian cancer underwent primary tumor reductive surgery followed by postoperative chemotherapy; however, neoadjuvant chemotherapy followed by interval tumor reductive surgery has gradually become an alternative approach for patients with advanced-stage ovarian cancer for whom primary tumor reductive surgery is not feasible. Decision-making about the use of these approaches has not been uniform. Hence, it is essential to identify patients who can benefit most from neoadjuvant chemotherapy followed by interval tumor reductive surgery. Several prospective and retrospective studies have proposed potential models to guide upfront decision-making for patients with advanced ovarian cancer. In this review, we summarize important decision-making models that can improve patient selection for personalized treatment. Models based on clinical factors (clinical parameters, radiology studies and laparoscopy scoring) and molecular markers (circulating and tumor-based) are useful, but laparoscopic staging is among the most informative diagnostic methods for upfront decision-making in patients medically fit for surgery. Further research is needed to explore more reliable models to determine personalized treatment for advanced epithelial ovarian cancer.

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

Cited by 12 publications

References 20 publications

<p>Feasibility and safety of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in patients with advanced stage ovarian cancer: a single-center experience</p>

<p>Feasibility and safety of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in patients with advanced stage ovarian cancer: a single-center experience</p>

Expression of resistance gene and prognosis of chemotherapy in primary epithelial ovarian cancer

Emerging Trends in Neoadjuvant Chemotherapy for Ovarian Cancer

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