and nutrition, and tries to keep an active lifestyle.
Her first CA-125 pre-cycle 1 was 100 U/mL and
after 3 cycles the marker drops to 20 U/mL. At the
completion of the course, the marker is 10 U/mL.
She has not experienced neuropathy and her CBC
was maintained throughout the course without the
need for growth factor support.
There are no phase 3 studies defining mainte-
nance chemotherapy as a treatment modality in
For patients who achieve clinical response following adjuvant chemotherapy, surveillance is
typically conducted every 3 months and consists
of history and physical examinations (pelvic examination minimum of twice per year) and monitoring
An early study examining the correlation of CA-
125 levels with disease progression found the
CA-125 to be elevated in 73% of patients at the
time of progression, with elevation of CA-125 levels occurring before clinical progression in 63%
of all patients.89 In patients who had elevated
CA-125 levels before clinical progression, the
median lag time was 4. 5 months (range 0.5–29.5
The Gynaecologic Cancer Intergroup (GCIG)
has proposed a set of criteria, based upon the
CA-125 level in conjunction with standard RECIST
(Response Evaluation Criteria in Solid Tumors)
criteria, to evaluate clinical response and progression in clinical trials conducted by its participating
groups.90 Specifically, the GCIG/RECIST criteria
for disease response is a 50% reduction in CA-125
levels that is maintained for 28 days. The CGIG/
RECIST criteria for disease progression are dependent on the patient’s CA-125 level prior to treatment. For patients with an initially elevated CA-125
level that normalized following treatment or for patients who had a normal CA-125 level, progression
is defined as a CA-125 level 2 times greater than
Risk factors BRCA1/2 HNPCC
Precursor lesions TIC Serous borderline
Atypical endometriosis Atypical endometriosis
Patterns of spread Very early
Transcoelomic Usually confined
Molecular abnormalities BRCA
Chemosensitivity High Intermediate Low High Low
Prognosis Poor Intermediate Favorable Favorable Intermediate
CCC = clear cell carcinoma; EC = endometrioid carcinoma; HGSC = high-grade serous carcinoma; LGSC = low-grade serous carcinoma;
MC = mucinous carcinoma; TIC = tubal intraepithelial carcinoma.
Adapted with permission from Prat J. New insights into ovarian cancer pathology. Ann Oncol 2012; 23(suppl 10):111–17.