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Normal CA-125 and the Risk of Progression in Ovarian Cancer

The University of Texas M.D. Anderson Cancer Center, Houston, TX

To the Editor:

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."

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. 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[Abstract/Free Full Text]

2. 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[Abstract/Free Full Text]

3. 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 (in press)[CrossRef][Medline]

4. Markman M: The use of PET scans in ovarian cancer: A diagnostic technique in search of an indication. J Clin Oncol 23:7385-7387[CrossRef][Medline]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Markman, M. Search for Related Content PubMed PubMed Citation Articles by Markman, M. Social Bookmarking                            What's this?