Normal CA-125 and the Risk of Progression in Ovarian Cancer
http://www.100md.com
《临床肿瘤学》
The University of Texas M.D. Anderson Cancer Center, Houston, TX
In a recent article in the Journal of Clinical Oncology, Santillan et al1 provide provocative data suggesting that even within the normal range, a persistently rising serum cancer antigen 125 (CA-125) provides strong evidence for progressive ovarian cancer. Despite this observation, which is supported by the analyses of others,2,3 the investigators appropriately conclude: "increasing within the normal range serum CA-125 levels should not be used as the sole indicator for starting potentially toxic therapy."1
Thus, it is rather surprising that Santillan et al complete their discussion with the following statement: "For selected patients with localized ovarian cancer recurrence that may benefit from secondary cytoreductive surgery, a comprehensive radiographic imaging survey (PET-CT) at the time of minimal CA-125 elevation may facilitate early detection and successful surgical resection."1 What existing phase III trial data support the clinical relevance associated with finding localized recurrent ovarian cancer or that a comprehensive imaging survey ("PET-CT") improves outcome in the setting of recurrent ovarian cancer?4 While a formal evaluation of the utility of early detection and surgical resection of recurrent ovarian cancer is a rational suggestion, this must be done through the conduct of a well-designed randomized phase III study.
Further, in the complete absence of evidence-based (phase III trial) data supporting this general management philosophy, it is difficult to accept the statement that this approach is appropriate for "selected patients" outside the setting of such a trial. The legitimate concern here is that the statement of Santillan et al, may (in fact) be used to justify an expensive, aggressive, potentially morbid, and unproven strategy in a "selected patient" with ovarian cancer who experiences a "rising serum CA-125 level with the normal range."
REFERENCES
Santillan A, Garg R, Zahurak ML, et al: Risk of epithelial ovarian recurrence in patients with rising serum CA-125 levels within the normal range. J Clin Oncol 23:9338-9343, 2005
Crawford SM, Peace J: Does the nadir CA-125 concentration predict a long-term outcome after chemotherapy for carcinoma of the ovary? Ann Oncol 16:47-50, 2005
Markman M, Liu PY, Rothenberg ML, et al: Relationship between pretreatment CA-125 and risk of relapse in advanced ovarian cancer patients achieving a clinical complete response who received maintenance therapy: A retrospective study of the Southwest Oncology Group and the Gynecologic Oncology Group. J Clin Oncol
Markman M: The use of PET scans in ovarian cancer: A diagnostic technique in search of an indication. J Clin Oncol 23:7385-7387(Maurie Markman)
In a recent article in the Journal of Clinical Oncology, Santillan et al1 provide provocative data suggesting that even within the normal range, a persistently rising serum cancer antigen 125 (CA-125) provides strong evidence for progressive ovarian cancer. Despite this observation, which is supported by the analyses of others,2,3 the investigators appropriately conclude: "increasing within the normal range serum CA-125 levels should not be used as the sole indicator for starting potentially toxic therapy."1
Thus, it is rather surprising that Santillan et al complete their discussion with the following statement: "For selected patients with localized ovarian cancer recurrence that may benefit from secondary cytoreductive surgery, a comprehensive radiographic imaging survey (PET-CT) at the time of minimal CA-125 elevation may facilitate early detection and successful surgical resection."1 What existing phase III trial data support the clinical relevance associated with finding localized recurrent ovarian cancer or that a comprehensive imaging survey ("PET-CT") improves outcome in the setting of recurrent ovarian cancer?4 While a formal evaluation of the utility of early detection and surgical resection of recurrent ovarian cancer is a rational suggestion, this must be done through the conduct of a well-designed randomized phase III study.
Further, in the complete absence of evidence-based (phase III trial) data supporting this general management philosophy, it is difficult to accept the statement that this approach is appropriate for "selected patients" outside the setting of such a trial. The legitimate concern here is that the statement of Santillan et al, may (in fact) be used to justify an expensive, aggressive, potentially morbid, and unproven strategy in a "selected patient" with ovarian cancer who experiences a "rising serum CA-125 level with the normal range."
REFERENCES
Santillan A, Garg R, Zahurak ML, et al: Risk of epithelial ovarian recurrence in patients with rising serum CA-125 levels within the normal range. J Clin Oncol 23:9338-9343, 2005
Crawford SM, Peace J: Does the nadir CA-125 concentration predict a long-term outcome after chemotherapy for carcinoma of the ovary? Ann Oncol 16:47-50, 2005
Markman M, Liu PY, Rothenberg ML, et al: Relationship between pretreatment CA-125 and risk of relapse in advanced ovarian cancer patients achieving a clinical complete response who received maintenance therapy: A retrospective study of the Southwest Oncology Group and the Gynecologic Oncology Group. J Clin Oncol
Markman M: The use of PET scans in ovarian cancer: A diagnostic technique in search of an indication. J Clin Oncol 23:7385-7387(Maurie Markman)