No benefit to early chemo for ovarian cancer relapse based on raised C125 concentration alone

For women whose ovarian cancer has been in remission, restarting chemotherapy early on the basis of heightened serum CA125 concentration does not improve survival compared with postponing treatment until symptoms of relapse appear, according to a study published in the Oct. 2, cancer-themed issue of The Lancet.

Gordon J.S. Rustin, MD, of the Mount Vernon Cancer Centre in Northwood, U.K., and colleagues enrolled 1,442 women with ovarian cancer in remission after first-line platinum-based chemotherapy, who had achieved a normal CA125 concentration. The researchers tracked each woman’s CA125 concentration every 3 months, and patients in whom the concentration exceeded twice the upper limit of normal were randomized to either early (265 subjects) or delayed (264 subjects) chemotherapy. Patients in the delayed-treatment group resumed treatment when symptoms recurred. The primary study outcome was overall survival.

Over a median follow-up of 56.9 months, there were 370 deaths, including 186 in the early-treatment group and 184 in the delayed-treatment group. The researchers found that median survival from randomization for the 2 groups was also similar, at 25.7 months and 27.1 months, respectively.

“Our findings showed no evidence of a survival benefit with early treatment of relapse on the basis of a raised CA125 concentration alone, and therefore the value of routine measurement of CA125 in the follow-up of patients with ovarian cancer who attain a complete response after first-line treatment is not proven,” the authors wrote.