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Case History

Image not available. A 58-year-old woman has completed six cycles of carboplatin and paclitaxel chemotherapy for a papillary serous carcinoma of the ovary that has been previously optimally debulked. At the end of treatment she is asymptomatic, there is no residual disease and her CA125 levels are within normal limits.

What follow-up will you recommend now? In particular, discuss the utility of measuring the CA125 during follow-up, and how it might direct your future actions.

Eight months following completion of carboplatin and paclitaxel chemotherapy the patient returns complaining of abdominal fullness. A computed tomography (CT) scan reveals a small amount of recurrent ascites and some diffuse omental disease.

What is the standard treatment option at this point, and on what evidence is it based?

Discuss the role of non-platinum-based treatment in relapsed ovarian cancer, and the evidence which supports choosing this treatment.

Background

What follow-up will you recommend now? In particular, discuss the utility of measuring the CA125 during follow-up, and how it might direct your future actions

Image not available. Unfortunately, despite initial good responses, most women with ovarian cancer usually have a relapse. There are retrospective data suggesting that response rates to second-line chemotherapy are improved with reduced tumour bulk (Image not available.5 cm versus ≥5 cm) and better performance status.1 This shows the importance of follow-up so that recurrent disease can be identified and treated at the optimum time; not too early when treatment toxicity outweighs its benefit, but not too late when there is a reduced chance of responding, and poorer reserves to cope with treatment. The results of two trials, OV05 and EORTC55955, are currently awaited to know whether there are survival differences between starting chemotherapy when CA125 increases in the absence of symptoms or starting chemotherapy when symptoms develop.

Most women with ovarian cancer show a rise in serum concentration of CA125 at diagnosis and relapse. There is evidence that nadir CA125 level attained and CA125 half-life are of prognostic value in ovarian cancer.2 In women with a raised CA125 at diagnosis, CA125 is a more sensitive marker of relapse than radiological monitoring. The recommended follow-up for ovarian cancer is therefore regular outpatient visits with CA125 levels checked each time. Radiological imaging is not routinely done outside the clinical trial setting unless there is clinical, or CA125, suspicion of progression. The exception may be the monitoring of the 10–20% of women who do not have raised CA125 at initial diagnosis, or those presenting with very early stage disease.

Discussion

What is the standard treatment option at this point, and on what evidence is it based?

Image not available. The treatment of ovarian cancer that has recurred is palliative, and therefore the primary aims of management are to prolong life, relieve symptoms attributable to the disease and maintain quality of life. Active drugs include platinum, taxanes, pegylated liposomal doxorubicin, ...

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