Gossner Gabrielle, Coleman Robert L, Mutch David G, Horowitz Neil S, Rader Janet S, Gibb Randall K, Powell Matthew A, Herzog Thomas J
Washington University School of Medicine, St. Louis, MO 63110, USA.
Gynecol Oncol. 2006 Oct;103(1):212-8. doi: 10.1016/j.ygyno.2006.02.026. Epub 2006 May 3.
Recent additions of novel chemotherapeutics, such as pegylated liposomal doxorubicin (PLD) and topotecan (TPT), have provided clinicians with multiple options for treating recurrent ovarian cancer. Evaluating treatment response in patients without radiographic or physically measurable disease is problematic, thereby CA-125 values may be the only available objective criteria. It has been advocated that several cycles of novel agents are required prior to an observed CA-125 response. In this study, we sought to gain insight into response patterns regarding CA-125 in responders vs. non-responders and to determine whether specific "cut-off" values could help predict ultimate clinical response.
Patients with recurrent ovarian cancer who received either single agent PLD, TPT, or both were included. CA-125 levels were evaluated prior to initiation of chemotherapy and thereafter for each additional cycle. The Rustin criteria were utilized to evaluate CA-125 response.
Fifty-four of 120 patients were judged to be responders. When comparing responders to non-responders, as expected, the majority of responders demonstrated a decrease after each of the first 4 cycles. However, nearly 50% of responders who received PLD demonstrated an increase in CA-125 after cycle 1. There were no responders who demonstrated two successive rises in CA-125.
The majority of patients with recurrent ovarian cancer who will ultimately manifest a CA-125 response to novel agents, such as TPT or PLD, will demonstrate a decrease following each cycle. An initial increase in CA-125 should not mandate discontinuation of current therapy, but a successive rise over two or more cycles reliably predicts that a treatment response ultimately is unlikely.
近期新型化疗药物的加入，如聚乙二醇化脂质体阿霉素（PLD）和拓扑替康（TPT），为临床医生治疗复发性卵巢癌提供了多种选择。评估无影像学或体格可测量疾病患者的治疗反应存在问题，因此CA-125值可能是唯一可用的客观标准。有人主张在观察到CA-125反应之前需要几个周期的新型药物治疗。在本研究中，我们试图深入了解反应者与无反应者在CA-125方面的反应模式，并确定特定的“临界”值是否有助于预测最终的临床反应。
纳入接受单药PLD、TPT或两者联合治疗的复发性卵巢癌患者。在化疗开始前及之后的每个周期评估CA-125水平。采用Rustin标准评估CA-125反应。
120例患者中有54例被判定为反应者。将反应者与无反应者进行比较时，正如预期的那样，大多数反应者在前4个周期中的每个周期后CA-125均下降。然而，接受PLD治疗的反应者中近50%在第1周期后CA-125升高。没有反应者的CA-125连续两次升高。
大多数最终会对TPT或PLD等新型药物表现出CA-125反应的复发性卵巢癌患者，在每个周期后CA-125会下降。CA-125最初升高不应要求停止当前治疗，但在两个或更多周期中连续升高可靠地预测最终不太可能出现治疗反应。
