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Cancer Biomarkers: Status and Its Future Direction. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Chelariu-Raicu A, Trillsch F, Burges A, Czogalla B, Hester A, Wuerstlein R, Harbeck N, Mahner S. PARP inhibitors: risk factors for toxicity and matching patients to the proper poly (ADP-ribose) polymerase inhibitor (PARPi) therapy. Int J Gynecol Cancer 2023; 33:812-822. [PMID: 36707086 DOI: 10.1136/ijgc-2022-003990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The past 5 years have seen several fundamental advances in ovarian cancer, with important new insights towards novel therapeutic opportunities within the DNA repair pathway. With the incorporation of poly (ADP-ribose) polymerase inhibitors (PARPi) into maintenance treatment regimens, the management of short- and long-term adverse events are key clinical priorities. Currently, three different PARPi are clinically beneficial and have been approved for primary and recurrent ovarian cancer: olaparib, niraparib, and rucaparib. The duration of treatment with PARPi in patients with ovarian cancer varies; patients can receive treatment for up to 2 or 3 years in first-line setting, or continue treatment until unacceptable toxicity or progression occurs in recurrent disease. Despite their similar mechanisms of action, these three inhibitors have specific toxicity profiles, which may lead to dose interruptions or discontinuation of treatment. This review summarizes the current indications for PARPi, including their role in recurrent and first-line maintenance treatment for advanced ovarian cancer. We also outline dose modifications leading to treatment disruption and potential changes in quality of life after prolonged treatment. Finally, we highlight the patient groups most likely to benefit from each of the three different PARPi.
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Affiliation(s)
- Anca Chelariu-Raicu
- Department of Obstetrics and Gynecology, Breast Center, Gynecologic Cancer Center and CCC Munich, Ludwig Maximilians University Munich, Munich, Bayern, Germany .,German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center, Munich, Germany
| | - Fabian Trillsch
- Department of Obstetrics and Gynecology, Breast Center, Gynecologic Cancer Center and CCC Munich, Ludwig Maximilians University Munich, Munich, Bayern, Germany
| | - Alexander Burges
- Department of Obstetrics and Gynecology, Breast Center, Gynecologic Cancer Center and CCC Munich, Ludwig Maximilians University Munich, Munich, Bayern, Germany
| | - Bastian Czogalla
- Department of Obstetrics and Gynecology, Breast Center, Gynecologic Cancer Center and CCC Munich, Ludwig Maximilians University Munich, Munich, Bayern, Germany
| | - Anna Hester
- Department of Obstetrics and Gynecology, Breast Center, Gynecologic Cancer Center and CCC Munich, Ludwig Maximilians University Munich, Munich, Bayern, Germany
| | - Rahel Wuerstlein
- Department of Obstetrics and Gynecology, Breast Center, Gynecologic Cancer Center and CCC Munich, Ludwig Maximilians University Munich, Munich, Bayern, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, Breast Center, Gynecologic Cancer Center and CCC Munich, Ludwig Maximilians University Munich, Munich, Bayern, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, Breast Center, Gynecologic Cancer Center and CCC Munich, Ludwig Maximilians University Munich, Munich, Bayern, Germany.,German Cancer Consortium (DKTK), partner site Munich, German Cancer Research Center, Munich, Germany
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3
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Glickman A, Paredes P, Carreras-Diéguez N, Niñerola-Baizán A, Gaba L, Pahisa J, Fusté P, Del Pino M, Díaz-Feijóo B, González-Bosquet E, Agustí N, Sánchez-Izquierdo N, Fuster D, Perissinotti A, Romero I, Fernández-Galán E, Carrasco JL, Gil-Ibáñez B, Torné A. Evaluation of patients with advanced epithelial ovarian cancer before primary treatment: correlation between tumour burden assessed by [ 18F]FDG PET/CT volumetric parameters and tumour markers HE4 and CA125. Eur Radiol 2021; 32:2200-2208. [PMID: 34586465 DOI: 10.1007/s00330-021-08305-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/11/2021] [Accepted: 08/25/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Accurate assessment of disease extent is required to select the best primary treatment for advanced epithelial ovarian cancer patients. Estimation of tumour burden is challenging and it is usually performed by means of a surgical procedure. Imaging techniques and tumour markers can help to estimate tumour burden non-invasively. 2-[18F]FDG PET/CT allows the evaluation of the whole-body disease. This study aimed to correlate HE4 and CA125 serum concentrations with tumour burden evaluated by volumetric 2-[18F]FDG PET/CT parameters in advanced high-grade epithelial ovarian cancer. METHODS We included 66 patients who underwent 2-[18F]FDG PET/CT and serum tumour markers determination before primary treatment. Volumes of interest were delimited in every pathological uptake. Whole-body metabolic tumour volume (wb_MTV) and total lesion glycolysis (wb_TLG) were calculated summing up every VOI's MTV value. SUVmax thresholds were set at 40% (MTV40 and TLG40) and 50% (MTV50 and TLG50). In addition, four VOI subgroups were defined: peritoneal carcinomatosis, retroperitoneal nodes, supradiaphragmatic nodes, and distant metastases. MTV and TLG were calculated for each group by adding up the corresponding MTV values. TLG was calculated likewise. RESULTS wb_MTV and wb_TLG were found to be significantly correlated with serum CA125 and HE4 concentrations. The strongest correlation was observed between HE4 and wb_MTV40 (r = 0.62, p < 0.001). Pearson's correlation coefficients between peritoneal carcinomatosis MTV40 and tumour markers were 0.61 (p < 0.0001) and 0.29 (p = 0.02) for HE4 and CA125 respectively. None of these tumour markers showed a positive correlation with tumour load outside the abdominal cavity assessed by volumetric parameters. CONCLUSION HE4 performs better than CA125 to predict metabolic tumour burden in high-grade epithelial ovarian cancer before primary treatment. 2-[18F]FDG PET/CT volumetric parameters arise as feasible tools for the objective assessment of tumour load and its anatomical distribution. These results support the usefulness of HE4 and PET/CT to improve the stratification of these patients in clinical practice. KEY POINTS • In patients with high-grade advanced ovarian epithelial carcinoma, both CA125 and HE4 correlate to whole-body tumour burden assessed by PET/CT before primary treatment. • HE4 estimates peritoneal disease much better than CA125. • PET/CT volumetric parameters arise as feasible tools for the objective assessment of tumour load and its anatomical distribution.
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Affiliation(s)
- Ariel Glickman
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Department of Nuclear Medicine, Hospital Clínic Barcelona, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Faculty of Medicine - University of Barcelona, Barcelona, Spain.
| | - Núria Carreras-Diéguez
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aida Niñerola-Baizán
- Department of Nuclear Medicine, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine - University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Lydia Gaba
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jaume Pahisa
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pere Fusté
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
- Faculty of Medicine - University of Barcelona, Barcelona, Spain
| | - Marta Del Pino
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine - University of Barcelona, Barcelona, Spain
| | - Berta Díaz-Feijóo
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine - University of Barcelona, Barcelona, Spain
| | - Eduardo González-Bosquet
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Núria Agustí
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - David Fuster
- Department of Nuclear Medicine, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine - University of Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clínic Barcelona, Barcelona, Spain
- Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Inmaculada Romero
- Department of Nuclear Medicine, Hospital Clínic Barcelona, Barcelona, Spain
| | - Esther Fernández-Galán
- Department of Biochemistry and Molecular Genetics, Biomedical Diagnostic Centre, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Lluís Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | - Blanca Gil-Ibáñez
- Gynecologic Oncology and Minimally Invasive Gynecologic Surgery Unit, Department of Obstetrics and Gynecology, 12 de Octubre University Hospital, Madrid, Spain
| | - Aureli Torné
- Gynaecologic Oncology Unit, Institut Clínic de GinecologiaObstetrícia i Neonatologia, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine - University of Barcelona, Barcelona, Spain
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Yi Q, Ran Y, Li C. The Effect of Delayed Chemotherapy on the Decrease of CA125 in Epithelial Ovarian Cancer During Coronavirus Disease Pandemic in 2020. Cancer Manag Res 2021; 13:515-520. [PMID: 33500665 PMCID: PMC7826069 DOI: 10.2147/cmar.s289773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate whether patients with epithelial ovarian cancer were affected by delayed chemotherapy during the coronavirus disease pandemic in 2020. Materials and Methods A delay of more than 21 days in the planned chemotherapy was defined as "delayed chemotherapy." Forty-five patients with epithelial ovarian, fallopian tube, and peritoneal cancer were delayed between January 1 and March 30, 2020 in the First Affiliated Hospital of Chongqing Medical University. Thirty-two cases were enrolled in this study. Neoadjuvant chemotherapy was used in 8 cases; palliative chemotherapy was used in 5 cases; and maintenance chemotherapy was used in 19 cases. Data included age, pathological type, surgical pathological stage, chemotherapy time and CA125 levels were collected. The half-life of CA125 and the decrease in CA125 levels before and after delayed chemotherapy were calculated. Results No patient got coronavirus disease. Compared with patients of ovarian cancer, fallopian tube epithelial cancer and peritoneal epithelial cancer in the same periods in 2019, the half-life of CA125 in neoadjuvant chemotherapy group and recurrence chemotherapy group were more than 20 days, but there was no significant difference. Only when the delayed chemotherapy took place before CA125 turned negative, accompanied by an interval of more than 60 days, the CA125 half-life and the decreased range of CA125 were totally affected. Conclusion There was no evidence to support that once chemotherapy was delayed it would influence the decrease of CA125, but whether it would affect the long-term effects such as recurrence and five-year survival rate remains to be further followed up.
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Affiliation(s)
- Qiang Yi
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yu Ran
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Cong Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Moharrag A, Yonbawi F, Bashawieh HH, Basabrain A, Al-Jifree HM. The Average Time Gap Between CA-125 Tumor Marker Elevation and Confirmation of Recurrence in Epithelial Ovarian Cancer Patients at Princess Noorah Oncology Center, Jeddah, Saudi Arabia. Cureus 2020; 12:e9518. [PMID: 32884874 PMCID: PMC7462651 DOI: 10.7759/cureus.9518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The monitoring of the tumor marker cancer antigen 125 (CA-125) is commonly used as a part of epithelial ovarian cancer monitoring for recurrence. This study seeks to calculate the average time between CA-125 elevation above 35 IU/mL and evidence of recurrence through any currently accepted modality (positive clinical findings, biopsy, imaging, or PET [positron emission tomography] findings) in a patient population in Jeddah, Saudi Arabia. We studied patients who were diagnosed between January 2006 and December 2016, underwent successful primary therapy, and were then followed up at Princess Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia. We adopted a cross-sectional chart review study design. We used inclusive (consecutive) sampling. A total of 13 patients were included, of whom 76.9% (10 patients) developed CA-125 elevations above 35 IU/mL prior to the confirmation of recurrence. If all 13 patients are included in the mean average calculation, the mean average time elapsed between CA-125 elevation and confirmation of recurrence was 161.5 days (standard deviation ± 230.6). If only the 10 patients who did exhibit a CA-125 elevation above 35 IU/mL were included, the mean average was 210 days (standard deviation ± 244.2).
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Affiliation(s)
- Ali Moharrag
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Faisal Yonbawi
- Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hussam H Bashawieh
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ahmed Basabrain
- Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hatim M Al-Jifree
- Oncology, Ministry of National Guard Health Affairs, Jeddah, SAU.,Oncology, King Abdullah International Medical Research Center, Jeddah, SAU
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Giampaolino P, Foreste V, Della Corte L, Di Filippo C, Iorio G, Bifulco G. Role of biomarkers for early detection of ovarian cancer recurrence. Gland Surg 2020; 9:1102-1111. [PMID: 32953625 DOI: 10.21037/gs-20-544] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ovarian cancer is frequently diagnosed at an advanced stage and a fraction of these patients fail to respond to primary therapy and relapses in 70% of cases. On account of the high recurrence probability and the poor outcomes after recurrence, there is an urgent need to predict progression as early as possible and thus found the strategies to detect and prevent a recurrence. Considering that biomarkers have contributed to the management of ovarian cancer by distinguishing benign and malignant pelvic masses and monitoring response to treatment, in this review, we aim to discuss the latest evidence reported in the literature about the use of biomarkers to detect OC recurrence. In detail, we summarized all the evidence of the most quoted biomarkers like HE4, osteopontin, mesothelin (MSLN), Folate receptor α (FOLR1), paraneoplastic antigens, miRNA, cancer stem cells (CSCs) and a combination of them to evaluate their role as prognostic biomarkers for ovarian cancer recurrence.
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Affiliation(s)
- Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Virginia Foreste
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Claudia Di Filippo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Iorio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Bae H, Jung DC, Lee JY, Nam EJ, Kang WJ, Oh YT. Patterns of initially overlooked recurrence of peritoneal lesions in patients with advanced ovarian cancer on postoperative multi-detector row CT. Acta Radiol 2019; 60:1713-1720. [PMID: 31081339 DOI: 10.1177/0284185119842832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Heejin Bae
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Chul Jung
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Taik Oh
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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Simmons AR, Fourkala EO, Gentry-Maharaj A, Ryan A, Sutton MN, Baggerly K, Zheng H, Lu KH, Jacobs I, Skates S, Menon U, Bast RC. Complementary Longitudinal Serum Biomarkers to CA125 for Early Detection of Ovarian Cancer. Cancer Prev Res (Phila) 2019; 12:391-400. [PMID: 30967390 DOI: 10.1158/1940-6207.capr-18-0377] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/13/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
Early detection of ovarian cancer has the potential to impact mortality. A multimodal screening strategy where rising CA125 values over time, analyzed with the risk of ovarian cancer algorithm (ROCA), triggers transvaginal sonography and possible surgery has high sensitivity and specificity, but still fails to detect the 20% of early-stage cases that do not express CA125. Use of multiple biomarkers could detect cases missed by CA125. We have studied the sensitivity and lead time of a multi-marker panel (CA125, HE4, MMP-7, and CA 72-4) compared with CA125 alone. We used PRoBE design principles to select preclinical longitudinal specimens from 75 women (50 screen-positive, 25 screen-negative) who developed invasive epithelial ovarian cancer (3-5 serial specimens each) and 547 corresponding healthy controls (1-10 serial specimens each) from the ovarian cancer screening trial, UKCTOCS, in a blinded fashion. We measured the multi-marker concentrations in ultra-low serum volumes (16 μL) utilizing multiplexed bead-based immunoassays with low detection limits, high inter- and intra-assay precision, negligible cross-reactivity, and good correlation with standard immunoassays. While, at least one of the complementary biomarkers rose with CA125 in 44% (22/50) of screen-positive cases, there was no advantage in lead time over CA125. Therefore, we developed single-marker longitudinal algorithms (ROCA-like) to determine the presence of a change point to distinguish between the cases and controls. Using these algorithms, at 98% specificity, HE4 and CA72-4 identified 16% (4/25) of screen-negative cases, while MMP-7 identified none. Taken together, HE4 and CA72-4 show promise as complementary biomarkers to CA125 for longitudinal screening.
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Affiliation(s)
- Archana R Simmons
- Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Evangelia Ourania Fourkala
- Department of Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom
| | - Aleksandra Gentry-Maharaj
- Department of Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom
| | - Andy Ryan
- Department of Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom
| | - Margie N Sutton
- Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Keith Baggerly
- Department of Bioinformatics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ian Jacobs
- Department of Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom
| | - Steven Skates
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Usha Menon
- Department of Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom
| | - Robert C Bast
- Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
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Abstract
Ovarian cancer is one of the most aggressive gynaecologic malignancies in women worldwide. The lack of proper screening programs and the characteristic abdominal spreading with minimal clinical symptoms give rise of its high lethality. Most patients show advanced disease at diagnosis and have a poor prognosis. The surveillance of ovarian cancer patients after initial treatment is a challenging question in clinical practice and there is no consensus in literature about the most appropriate follow-up strategy for these women. The role of Imaging has become increasingly important, allowing to properly monitor patients, distinguishing the different relapse patterns, thus guiding the correct management and therapy. In this review, we report and analyze the scientific evidence about the role of the different imaging modalities now available in the follow-up strategy and management of Epithelial Ovarian Cancer patients with recurrent disease.
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Secondary cytoreductive surgery - viable treatment option in the management of platinum-sensitive recurrent ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2018; 228:154-160. [PMID: 29957400 DOI: 10.1016/j.ejogrb.2018.06.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of the secondary cytoreductive surgery on survival parameters in women with platinum-sensitive recurrent ovarian cancer who undergone secondary cytoreduction following chemotherapy compared to women who recieved chemotherapy alone. STUDY DESIGN In a retrospective study, data were rewieved from women who were diagnosed and treated with ovarian cancer and its primary platinum-sensitive recurrence at the University Hospital Brno in the Czech Republic between November 2009 and March 2016. Out of the total number of 62 patients with recurrence, 30 women underwent cytoreductive surgery plus chemotherapy and 32 were treated with chemotherapy alone. The good performance status expressed by ECOG score 0-1, the single site of recurrence regardless of platinum-free interval or multiple sites of recurrence but no carcinomatosis and platinum-free interval >12 months, and no or small-volume ascites (<500 ml) were considered inclusion criteria for cytoreductive surgery. Women not meeting these criteria were treated by chemotherapy alone. Descriptive statistics, Kaplan-Meier survival curves and Log-Rank test were used for statistical estimations. RESULTS The analysis confirmed more favorable prognosis in patient group treated with a combination secondary cytoreduction and chemotherapy. Mean disease-free survival (DFS) was 49.8 months (95% CI; 33.2-66.3) and mean overall survival (OS) stood at 54.0 months (95% CI; 39.4-68.6) in this patient cohort, while in patient group treated with chemotherapy alone it was found that mean DFS was 16.6 months (95% CI; 7.4-25.8) and mean OS stood at 26.2 months (95% CI; 16.6-35.8). When testing the difference between survival curves, statistically significant differences were observed in both DFS (p = 0.010) and OS (p = 0.007) rates between two treatment groups. Age < 60 years at the time of recurrence and zero macroscopic residual disease after secondary cytoreduction were identified as favorable prognostic factors for both DFS and OS in a multivariate analysis. CONCLUSION Secondary cytoreductive surgery is acceptable as a viable treatment option for highly selected women with ovarian cancer recurrence. Complete resection is considered ultimate goal of secondary cytoreduction on condition that the balance between maximal survival gain and minimal operative morbidity will be kept.
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11
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Lin DC, Genzen JR. Concordance analysis of paired cancer antigen (CA) 15-3 and 27.29 testing. Breast Cancer Res Treat 2017; 167:269-276. [DOI: 10.1007/s10549-017-4513-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 09/13/2017] [Indexed: 12/22/2022]
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12
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Kline JB, Kennedy RP, Albone E, Chao Q, Fernando S, McDonough JM, Rybinski K, Wang W, Somers EB, Schweizer C, Grasso L, Nicolaides NC. Tumor antigen CA125 suppresses antibody-dependent cellular cytotoxicity (ADCC) via direct antibody binding and suppressed Fc-γ receptor engagement. Oncotarget 2017; 8:52045-52060. [PMID: 28881712 PMCID: PMC5581011 DOI: 10.18632/oncotarget.19090] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/19/2017] [Indexed: 12/31/2022] Open
Abstract
Cancers employ a number of mechanisms to evade host immune responses. Here we report the effects of tumor-shed antigen CA125/MUC16 on suppressing IgG1-mediated antibody-dependent cellular cytotoxicity (ADCC). This evidence stems from prespecified subgroup analysis of a Phase 3 clinical trial testing farletuzumab, a monoclonal antibody to folate receptor alpha, plus standard-of-care carboplatin-taxane chemotherapy in patients with recurrent platinum-sensitive ovarian cancer. Patients with low serum CA125 levels treated with farletuzumab demonstrated improvements in progression free survival (HR 0.49, p = 0.0028) and overall survival (HR 0.44, p = 0.0108) as compared to placebo. Farletuzumab’s pharmacologic activity is mediated in part through ADCC. Here we show that CA125 inhibits ADCC by directly binding to farletuzumab that in turn perturbs Fc-γ receptor engagement on effector cells.
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Role of 18F-FDG PET/CT in the detection of ovarian cancer recurrence in the setting of normal tumor markers. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mahajan A, Sable NP, Popat PB, Bhargava P, Gangadhar K, Thakur MH, Arya S. Magnetic Resonance Imaging of Gynecological Malignancies: Role in Personalized Management. Semin Ultrasound CT MR 2016; 38:231-268. [PMID: 28705370 DOI: 10.1053/j.sult.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Nilesh P Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Palak B Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.
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Clinical Use of Cancer Biomarkers in Epithelial Ovarian Cancer: Updated Guidelines From the European Group on Tumor Markers. Int J Gynecol Cancer 2016; 26:43-51. [PMID: 26588231 PMCID: PMC4679342 DOI: 10.1097/igc.0000000000000586] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
To present an update of the European Group on Tumor Markers guidelines for serum markers in epithelial ovarian cancer.
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16
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Front-line intraperitoneal versus intravenous chemotherapy in stage III-IV epithelial ovarian, tubal, and peritoneal cancer with minimal residual disease: a competing risk analysis. BMC Cancer 2016; 16:235. [PMID: 26988703 PMCID: PMC4797353 DOI: 10.1186/s12885-016-2279-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 03/13/2016] [Indexed: 12/30/2022] Open
Abstract
Background In the analysis of survival data for cancer patients, the problem of competing risks is often ignored. Competing risks have been recognized as a special case of time-to-event analysis. The conventional techniques for time-to-event analysis applied in the presence of competing risks often give biased or uninterpretable results. Methods Using a prospectively collected administrative health care database in a single institution, we identified patients diagnosed with stage III or IV primary epithelial ovarian, tubal, and peritoneal cancers with minimal residual disease after primary cytoreductive surgery between 1995 and 2012. Here, we sought to evaluate whether intraperitoneal chemotherapy outperforms intravenous chemotherapy in the presence of competing risks. Unadjusted and multivariable subdistribution hazards models were applied to this database with two types of competing risks (cancer-specific mortality and other-cause mortality) coded to measure the relative effects of intraperitoneal chemotherapy. Results A total of 1263 patients were recruited as the initial cohort. After propensity score matching, 381 patients in each arm entered into final competing risk analysis. Cumulative incidence estimates for cancer-specific mortality were statistically significantly lower (p = 0.017, Gray test) in patients receiving intraperitoneal chemotherapy (5-year estimates, 34.5 %; 95 % confidence interval [CI], 29.5–39.6 %, and 10-year estimates, 60.7 %; 95 % CI, 52.2–68.0 %) versus intravenous chemotherapy (5-year estimates, 41.3 %; 95 % CI, 36.2–46.3 %, and 10-year estimates, 67.5 %, 95 % CI, 61.6–72.7 %). In subdistribution hazards analysis, for cancer-specific mortality, intraperitoneal chemotherapy outperforms intravenous chemotherapy (Subdistribution hazard ratio, 0.82; 95 % CI, 0.70–0.96) after correcting other covariates. Conclusions In conclusion, results from this comparative effectiveness study provide supportive evidence for previous published randomized trials that intraperitoneal chemotherapy outperforms intravenous chemotherapy even eliminating the confounding of competing risks. We suggest that implementation of competing risk analysis should be highly considered for the investigation of cancer patients who have medium to long-term follow-up period. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2279-0) contains supplementary material, which is available to authorized users.
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17
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Sharma SK, Sevak KK, Monette S, Carlin SD, Knight JC, Wuest FR, Sala E, Zeglis BM, Lewis JS. Preclinical 89Zr Immuno-PET of High-Grade Serous Ovarian Cancer and Lymph Node Metastasis. J Nucl Med 2016; 57:771-6. [PMID: 26837339 DOI: 10.2967/jnumed.115.167072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/07/2016] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The elevation of cancer antigen 125 (CA125) levels in the serum of asymptomatic patients precedes the radiologic detection of high-grade serous ovarian cancer by at least 2 mo and the final clinical diagnosis by 5 mo. PET imaging of CA125 expression by ovarian cancer cells may enhance the evaluation of the extent of disease and provide a roadmap to surgery as well as detect recurrence and metastases. METHODS (89)Zr-labeled mAb-B43.13 was synthesized to target CA125 and evaluated via PET imaging and biodistribution studies in mice bearing OVCAR3 human ovarian adenocarcinoma xenografts. Ex vivo analysis of tumors and lymph nodes was performed via autoradiography, histopathology, and immunohistochemistry. RESULTS PET imaging using (89)Zr-DFO-mAb-B43.13 (DFO is desferrioxamine) clearly delineated CA125-positive OVCAR3 xenografts as early as 24 h after the administration of the radioimmunoconjugate. Biodistribution studies revealed accretion of (89)Zr-DFO-mAb-B43.13 in the OVCAR3 tumors, ultimately reaching 22.3 ± 6.3 percentage injected dose per gram (%ID/g) at 72 h after injection. Most interestingly, activity concentrations greater than 50 %ID/g were observed in the ipsilateral lymph nodes of the xenograft-bearing mice. Histopathologic analysis of the immuno-PET-positive lymph nodes revealed the presence of grossly metastasized ovarian cancer cells within the lymphoid tissues. In control experiments, only low-level, non-specific uptake of (89)Zr-labeled isotype IgG was observed in OVCAR3 tumors; similarly, low-activity concentrations of (89)Zr-DFO-mAb-B43.13 accumulated in CA125-negative SKOV3 tumors. CONCLUSION Immuno-PET with (89)Zr-labeled mAb-B43.13 is a potential strategy for the noninvasive delineation of extent of disease and may add value in treatment planning and treatment monitoring of high-grade serous ovarian cancer.
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Affiliation(s)
- Sai Kiran Sharma
- Department of Radiology and the Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Kuntal K Sevak
- Department of Radiology and the Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sebastien Monette
- Tri-Institutional Laboratory of Comparative Pathology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, and The Rockefeller University, New York, New York
| | - Sean D Carlin
- Department of Radiology and the Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James C Knight
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Frank R Wuest
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Brian M Zeglis
- Department of Chemistry, Hunter College and the Graduate Center of the City University of New York, New York, New York
| | - Jason S Lewis
- Department of Radiology and the Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
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18
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Liu L, Xiang J, Chen R, Fu D, Hong D, Hao J, Li Y, Li J, Li S, Mou Y, Mai G, Ni Q, Peng L, Qin R, Qian H, Shao C, Sun B, Sun Y, Tao M, Tian B, Wang H, Wang J, Wang L, Wang W, Wang W, Zhang J, Zhao G, Zhou J, Yu X. The clinical utility of CA125/MUC16 in pancreatic cancer: A consensus of diagnostic, prognostic and predictive updates by the Chinese Study Group for Pancreatic Cancer (CSPAC). Int J Oncol 2015; 48:900-7. [PMID: 26718269 DOI: 10.3892/ijo.2015.3316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/28/2015] [Indexed: 02/05/2023] Open
Abstract
The prognosis for pancreatic cancer (PC) is poor; however, the timely and accurate treatment of this disease will significantly improve prognosis. Serum biomarkers involve non-invasive tests that facilitate the early detection of tumors, predict outcomes and assess responses to therapy, so that the patient can be continuously monitored and receive the most appropriate therapy. Studies have reported that cancer antigen (CA)125 [also known as mucin 16 (MUC16)] has functional significance in the tumorigenic, metastatic and drug resistant properties of PC. Our aim was to use this biomarker in the diagnosis, detection of metastasis, prognosis and in the monitoring of the treatment effects of PC. Members of the Chinese Study Group for Pancreatic Cancer (CSPAC) reviewed the literature on CA125/MUC16 and developed an objective consensus on the clinical utility of CA125/MUC16 for PC. They confirmed the role of CA125/MUC16 in tumorigenesis and the progression of PC, and recommended monitoring CA125/MUC16 levels in all aspects of the diagnosis and treatment of PC, particularly those that involve the monitoring of treatments. In addition, they suggested that the combination of other biomarkers and imaging techniques, together with CA125/MUC16, would improve the accuracy of the clinical decision-making process, thereby facilitating the optimization of treatment strategies. Periodic clinical updates of the use of CA125/MUC16 have been established, which are important for further analyses and comparisons of clinical results from affiliates and countries, particularly as regards the in-depth biological function and clinical translational research of this biomarker.
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Affiliation(s)
- Liang Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Jinfeng Xiang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Rufu Chen
- Department of Pancreaticobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Deliang Fu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Defei Hong
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P.R. China
| | - Jihui Hao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, P.R. China
| | - Yixiong Li
- Department of Pancreatic-Bililary Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Jiangtao Li
- Department of Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Shengping Li
- Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Yiping Mou
- Department of Gastroenterological and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, P.R. China
| | - Gang Mai
- Department of Hepatobiliopancreatic Surgery, The People's Hospital of Deyang, Deyang, P.R. China
| | - Quanxing Ni
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Li Peng
- Department of Hepato-Pancreato-Biliary Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Honggang Qian
- Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, P.R. China
| | - Chenghao Shao
- Department of Pancreatic-Biliary Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P.R. China
| | - Yongwei Sun
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Min Tao
- Department of Medical Oncology, The First Hospital Affiliated to Soochow University, Suzhou, P.R. China
| | - Bole Tian
- Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hongxia Wang
- Department of Medical Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Jian Wang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Liwei Wang
- Department of Medical Oncology, Shanghai First People's Hospital, Shanghai, P.R. China
| | - Wei Wang
- Department of Surgery, Huadong Hospital, Fudan University, Shanghai, P.R. China
| | - Weilin Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Hangzhou, Zhejiang, P.R. China
| | - Jun Zhang
- Department of Medical Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Gang Zhao
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Jun Zhou
- Department of Medical Oncology, Peking University School of Oncolocy, Beijing Institute for Cancer Research, Beijing, P.R. China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
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Clinical Use of Cancer Biomarkers in Epithelial Ovarian Cancer: Updated Guidelines From the European Group on Tumor Markers. Int J Gynecol Cancer 2015. [PMID: 26588231 DOI: 10.1097/igc.0000000000000586] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To present an update of the European Group on Tumor Markers guidelines for serum markers in epithelial ovarian cancer. METHODS Systematic literature survey from 2008 to 2013. The articles were evaluated by level of evidence and strength of recommendation. RESULTS Because of its low sensitivity (50-62% for early stage epithelial ovarian cancer) and limited specificity (94-98.5%), cancer antigen (CA) 125 (CA125) is not recommended as a screening test in asymptomatic women. The Risk of Malignancy Index, which includes CA125, transvaginal ultrasound, and menopausal status, is recommended for the differential diagnosis of a pelvic mass. Because human epididymis protein 4 has been reported to have superior specificity to CA125, especially in premenopausal women, it may be considered either alone or as part of the risk of ovarian malignancy algorithm, in the differential diagnosis of pelvic masses, especially in such women. CA125 should be used to monitor response to first-line chemotherapy using the previously published criteria of the Gynecological Cancer Intergroup, that is, at least a 50% reduction of a pretreatment sample of 70 kU/L or greater. The value of CA125 in posttherapy surveillance is less clear. Although a prospective randomized trial concluded that early administration of chemotherapy based on increasing CA125 levels had no effect on survival, European Group on Tumor Markers state that monitoring with CA125 in this situation should occur, especially if the patient is a candidate for secondary cytoreductive surgery. CONCLUSIONS At present, CA125 remains the most important biomarker for epithelial ovarian cancer, excluding tumors of mucinous origin.
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Chang C, Chiang AJ, Chen WA, Chang HW, Chen J. A joint model based on longitudinal CA125 in ovarian cancer to predict recurrence. Biomark Med 2015; 10:53-61. [PMID: 26565119 DOI: 10.2217/bmm.15.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIMS To develop a new package of joint model to fit longitudinal CA125 in epithelial ovarian cancer relapse. PATIENTS & METHODS Included were 305 epithelial ovarian cancer patients who reached complete remission after cytoreductive surgery and first-line chemotherapy. Univariate and multivariate analysis with a joint model was performed to select independent risk factors, which were subsequently combined to predict recurrence. RESULTS Independent factors were longitudinal CA125, age, stage and residual tumor size (p < 0.05). Prediction of recurrence with these factors had an average of 80.7% accuracy, 5.6-10.7% better than kinetic factors. CONCLUSION The new package of joint model fits longitudinal CA125 well. Potential application can be extended to other biomarkers.
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Affiliation(s)
- Chung Chang
- Department of Applied Mathematics, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
| | - An Jen Chiang
- Department of Obstetrics & Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.,Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China.,Department of Pharmacy & Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung, Taiwan, Republic of China
| | - Wei-An Chen
- Department of Applied Mathematics, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
| | - Hsueh-Wen Chang
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
| | - Jiabin Chen
- Multidisciplinary Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China.,Da-Yeh University, Changhua, Taiwan, Republic of China
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Sharma SK, Wuest M, Wang M, Glubrecht D, Andrais B, Lapi SE, Wuest F. Immuno-PET of epithelial ovarian cancer: harnessing the potential of CA125 for non-invasive imaging. EJNMMI Res 2014; 4:60. [PMID: 26116121 PMCID: PMC4883985 DOI: 10.1186/s13550-014-0060-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/24/2014] [Indexed: 12/22/2022] Open
Abstract
Background Epithelial ovarian cancer (EOC) is characterized by the overexpression of cancer antigen 125 (CA125), a mucinous glycoprotein that serves as a tumor biomarker. Early diagnosis of EOC is plagued by its asymptomatic nature of progression and the limitations of currently used immunoassay techniques that detect CA125 as a shed antigen in serum samples. Presently, there is no technique available for the in vivo evaluation of CA125 expression in malignant tissues. Moreover, there could be an unexplored pathophysiological time window for the detection of CA125 in EOC, during which it is expressed on tumor cells prior to being shed into the bloodstream. A method for the in vivo evaluation of CA125 expression on ovarian neoplasms earlier along disease progression and/or recurrence can potentially contribute to better disease management. To this end, the present work utilizes an anti-CA125 monoclonal antibody (MAb) and a single-chain variable fragment (scFv) labeled with the positron-emitting radionuclide 64Cu for preclinical molecular imaging of CA125 expression in vivo. Methods Anti-CA125 MAb and scFv were prepared and functionally characterized for target binding prior to being tested as radiotracers in a preclinical setting. Results Immunoblotting, immunofluorescence, and flow cytometry revealed specific binding of CA125-targeting vectors to NIH:OVCAR-3 cells and no binding to antigen-negative SKOV3 cells. 64Cu-labeled anti-CA125 MAb and scFv were obtained in specific activities of 296 and 122 MBq/mg, respectively. Both radioimmunoconjugate vectors demonstrated highly selective binding to NIH:OVCAR-3 cells and virtually no binding to SKOV3 cells. In vivo radiopharmacological evaluation using xenograft mouse models injected with 64Cu-labeled anti-CA125 MAb provided a standardized uptake value (SUV) of 5.76 (29.70 %ID/g) in OVCAR3 tumors 24 h post-injection (p.i.) versus 1.80 (5.91 %ID/g) in SKOV3 tumors. 64Cu-labeled anti-CA125 scFv provided an SUV of 0.64 (3.21 %ID/g) in OVCAR3 tumors 24 h p.i. versus 0.25 (1.49 %ID/g) in SKOV3 tumors. Results from small-animal PET imaging were confirmed by ex vivo autoradiography and immunohistochemistry. Conclusions Radiolabeling of anti-CA125 MAb and scFv with 64Cu did not compromise their immunoreactivity. Both radioimmunoconjugates presented specific tumor uptake and expected biological clearance profiles. This renders them as potential immuno-PET probes for targeted in vivo molecular imaging of CA125 in EOC. Electronic supplementary material The online version of this article (doi:10.1186/s13550-014-0060-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sai Kiran Sharma
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 8613 - 114 Street, Edmonton, AB, T6G 2H1, Canada,
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Clarke T, Galaal K, Bryant A, Naik R. Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment. Cochrane Database Syst Rev 2014; 2014:CD006119. [PMID: 25198378 PMCID: PMC6457804 DOI: 10.1002/14651858.cd006119.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ovarian cancer is the sixth most common cancer and seventh commonest cause of death in women worldwide. Traditionally, many people who have been treated for cancer undergo long-term follow-up in secondary care. However, it has been suggested that the use of routine review may not be effective in improving survival, quality of life (QoL), or relieving anxiety, or both. In addition, traditional follow-up may not be cost-effective. OBJECTIVES To compare the potential benefits of different strategies of follow-up in patients with epithelial ovarian cancer following completion of primary treatment. SEARCH METHODS For this update we searched the Cochrane Gynaecological Cancer Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 7, 2013, MEDLINE and EMBASE from November 2010 to July 2013. We also searched reference lists of review articles and contacted experts in the field. SELECTION CRITERIA All relevant randomised controlled trials (RCTs) that evaluated follow-up strategies for women with epithelial ovarian cancer following completion of primary treatment. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. MAIN RESULTS The authors did not identify any new studies that were eligible for inclusion in this update of the review. The search for the original review identified only one RCT that met the inclusion criteria, which included 529 women. This study reported data on immediate treatment of ovarian cancer relapse following rise of serum CA125 levels versus delaying treatment until symptoms developed. All the women participating had previous confirmation of remission, with normal CA125 concentration and no radiological evidence of disease, after surgery and first-line chemotherapy for ovarian cancer.Overall survival between the immediate and delayed arms showed no difference after a median follow-up of 56.9 months (unadjusted hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.80 to 1.20; P value 0.85). Time from randomisation to first deterioration in global health score or death was shorter in the immediate treatment group than in the delayed treatment group (HR 0.71, 95% CI 0.58 to 0.88; P value < 0.01). The trial was at low risk of bias. AUTHORS' CONCLUSIONS Limited evidence from a single trial suggests that routine surveillance with CA125 in asymptomatic patients and treatment at CA125 relapse does not seem to offer survival advantage when compared to treatment at symptomatic relapse. RCTs are needed to compare different types of follow-up, looking at survival, QoL, cost and psychological effects as outcomes.
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Affiliation(s)
- Tilean Clarke
- London Metropolitan University166‐220 Holloway RdLondonUKN7 8DB
| | - Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Raj Naik
- Northern Gynaecological Oncology CentreGynaecological OncologyQueen Elizabeth HospitalGatesheadTyne and WearUKNE9 6SX
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Jeong HM, Kwon MJ, Shin YK. Overexpression of Cancer-Associated Genes via Epigenetic Derepression Mechanisms in Gynecologic Cancer. Front Oncol 2014; 4:12. [PMID: 24551595 PMCID: PMC3912470 DOI: 10.3389/fonc.2014.00012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 01/20/2014] [Indexed: 12/15/2022] Open
Abstract
Like other cancers, most gynecologic cancers are caused by aberrant expression of cancer-related genes. Epigenetics is one of the most important gene expression mechanisms, which contribute to cancer development and progression by regulating cancer-related genes. Since the discovery of differential gene expression patterns in cancer cells when compared with normal cells, extensive efforts have been made to explore the origins of abnormal gene expression in cancer. Epigenetics, the study of inheritable changes in gene expression that do not alter DNA sequence is a key area of this research. DNA methylation and histone modification are well-known epigenetic mechanisms, while microRNAs and alternative splicing have recently been identified as important regulators of epigenetic mechanisms. These mechanisms not only affect specific target gene expression but also regulate the functioning of other epigenetic mechanisms. Moreover, these diverse epigenetic regulations occur simultaneously. Epigenetic regulation of gene expression is extraordinarily complicated and all epigenetic mechanisms to be studied at once to determine the exact gene regulation mechanisms. Traditionally, the contribution of epigenetics to cancer is thought to be mediated through the inactivation of tumor suppressor genes expression. But recently, it is arising that some oncogenes or cancer-promoting genes (CPGs) are overexpressed in diverse type of cancers through epigenetic derepression mechanism, such as DNA and histone demethylation. Epigenetic derepression arises from diverse epigenetic changes, and all of these mechanisms actively interact with each other to increase oncogenes or CPGs expression in cancer cell. Oncogenes or CPGs overexpressed through epigenetic derepression can initiate cancer development, and accumulation of these abnormal epigenetic changes makes cancer more aggressive and treatment resistance. This review discusses epigenetic mechanisms involved in the overexpression of oncogenes or CPGs via epigenetic derepression in gynecologic cancers. Therefore, improved understanding of these epigenetic mechanisms will provide new targets for gynecologic cancer treatment.
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Affiliation(s)
- Hae Min Jeong
- Laboratory of Molecular Pathology and Cancer Genomics, College of Pharmacy, Seoul National University , Seoul , South Korea
| | - Mi Jeong Kwon
- College of Pharmacy, Kyungpook National University , Daegu , South Korea ; Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University , Daegu , South Korea
| | - Young Kee Shin
- Laboratory of Molecular Pathology and Cancer Genomics, College of Pharmacy, Seoul National University , Seoul , South Korea ; Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University , Seoul , South Korea ; Advanced Institutes of Convergence Technology , Suwon , South Korea ; Bio-MAX Institute, Seoul National University , Seoul , South Korea
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Marcus CS, Maxwell GL, Darcy KM, Hamilton CA, McGuire WP. Current approaches and challenges in managing and monitoring treatment response in ovarian cancer. J Cancer 2014; 5:25-30. [PMID: 24396495 PMCID: PMC3881218 DOI: 10.7150/jca.7810] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/25/2013] [Indexed: 12/13/2022] Open
Abstract
Epithelial ovarian cancer is the leading cause of death among gynecologic malignancies. Treatment of recurrent ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. A goal of many providers is to detect recurrences as early as possible and initiate treatment though there is controversy as to whether this impacts outcome. Elevations in CA125 and radiological findings may precede symptoms of recurrence by several months. While detection of recurrences by physical exam alone is unusual, a thorough exam in conjunction with reported symptoms and elevated CA125 is sufficient to detect 80-90% of recurrences. A spiral CT scan may be used to confirm recurrence in the setting of asymptomatic CA125 elevation and a PET/CT can yield additional insight if the CT is inconclusive. Initiating chemotherapy prior to the development of symptoms, even in the setting of elevated CA125, does not impact overall survival primarily because the efficacy of available treatments in the recurrent setting is poor. More information about tumor biology and ways to predict which patients will benefit from available treatment options is required. Consequently, the approach to post-treatment surveillance should be individualized taking into account the clinical benefit of the second-line therapy, versus the costs and morbidity of the surveillance method.
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Affiliation(s)
- Charlotte S Marcus
- 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 2. Gynecologic Oncology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - G Larry Maxwell
- 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 3. Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA22042, USA
| | - Kathleen M Darcy
- 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA
| | - Chad A Hamilton
- 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 2. Gynecologic Oncology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - William P McGuire
- 4. Department of Medicine, Inova Fairfax Hospital, Falls Church, VA 22042, USA
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Falzarano R, Viggiani V, Michienzi S, Colaprisca B, Longo F, Frati L, Anastasi E. CLEIA CA125 evidences: good analytical performance avoiding “Hook effect”. Tumour Biol 2012; 34:387-93. [DOI: 10.1007/s13277-012-0561-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/12/2012] [Indexed: 01/26/2023] Open
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