Utility of CA 125 in Determining the Response to Neoadjuvant Chemotherapy

• Published in: Indian journal of gynecologic oncology Vol. 20; no. 2
• Main Authors: Yadav, Neelu, Podder, Anirudha Rohit
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01-06-2022
• Subjects: Medicine; Medicine & Public Health; Oncology; Original Article; Surgical Oncology; Neoadjuvant chemotherapy; Primary Debulking; Interval Debulking; CA 125
• ISSN: 2363-8397; 2363-8400
• DOI: 10.1007/s40944-022-00622-3

Background
CA-125 is the tumor marker for surface epithelial carcinoma of ovary, and it is used to determine the response to chemotherapy, relapse, and disease progression. Neoadjuvant chemotherapy followed by interval debulking surgery is an acceptable treatment for patients with advanced disease. Most patients will require 2–4 cycles of neoadjuvant chemotherapy. However, some patients receive more than 4 cycles of neoadjuvant chemotherapy in many centers, and the most common reason for this is extensive disease at the beginning of neoadjuvant chemotherapy.
Purpose
To determine if a normal CA-125 level following neoadjuvant chemotherapy is an indicator of satisfactory reduction in the extent of the disease and should CA-125 levels be considered in deciding the number of cycles of neoadjuvant chemotherapy.
Methods
The histopathology report of all patients who underwent successful interval cytoreduction between 01-09-2020 and 31-08-2021 was analyzed to determine if the preoperative CA-125 level following neoadjuvant chemotherapy is reflective of the extent of disease resolution.
Results
There was no correlation between the pre-neoadjuvant chemotherapy CA-125 level, pre-operative CA-125 level, and the histopathology report. Some patients with a very high pre-neoadjuvant chemotherapy and pre-operative CA-125 level had no extra-ovarian involvement. Conversely, some patients with a low pre-neoadjuvant chemotherapy and a pre-operative CA-125 level had significant extra-ovarian involvement.
Conclusion
After how many cycles of neoadjuvant chemotherapy should surgery be performed must be decided by clinical examination and imagining. The purpose of neoadjuvant chemotherapy is to increase the rate of achieving complete cytoreduction in patients with extensive disease and poor performance status. Administering more than 3–4 cycles can be counterproductive.