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Poor Concordance Between CA-125 and RECIST Assessment for Progression in Platinum-Sensitive Relapsed Ovarian Cancer Maintenance Therapy With a PARPi

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Below is the abstract of the article. or on the link below.

Purpose

Cancer antigen-125 (CA-125) is recommended by treatment guidelines and widely used to diagnose ovarian cancer recurrence. The value of CA-125 as a surrogate for disease progression (PD) and its concordance with radiologic progression are unclear, particularly for women with platinum-sensitive relapsed ovarian cancer (PSROC) who have responded to chemotherapy and treated with maintenance poly(ADP-ribose) polymerase inhibitor (PARPi).

Methods

In this pooled analysis of four randomized trials of maintenance PARPi or placebo (Study 19, SOLO2, ARIEL3, and NOVA), we extracted data on CA-125 PD as defined by Gynecologic Cancer InterGroup criteria and RECIST v1.1. We evaluated the concordance between CA-125 and RECIST PD and reported on the negative predictive value (NPV) and positive predictive value (PPV).

Results

Of 1,262 participants (n = 818 PARPi, n = 444 placebo), 403 (32%) had CA-125 PD, and of these, 366 had concordant RECIST PD (PPV 91% [95% CI 88-93]). However, of 859 (68%) without CA-125 PD, 382 also did not have RECIST PD (NPV 44% [95% CI 41-48]). Within the treatment arms, PPV remained high (PARPi 91% [95% CI 86-94]; placebo 91% [95% CI 86-95]) but NPV was lower on placebo (PARPi 53% [95% CI 49-57]; placebo 25% [95% CI 20-31]). Of 477 with RECIST-only PD, most (95%) had a normal CA-125 at the start of maintenance therapy and the majority (n = 304, 64%) had CA-125 that remained within normal range. Solid organ recurrence without peritoneal disease was more common in those with RECIST-only PD than in those with CA-125 and RECIST PD (36% vs 24%, P<0.001).

Conclusion

In patients with PSROC treated with maintenance PARPi, almost half with RECIST PD did not have CA-125 PD, challenging current guidelines. Periodic computed tomography imaging should be considered as part of surveillance, particularly in those with a normal CA-125 at the start of maintenance therapy and on treatment.

Read an interview about the study here and expert commentary about it here.

Read the full article

Poor Concordance Between CA-125 and RECIST Assessment for Progression in Platinum-Sensitive Relapsed Ovarian Cancer Maintenance Therapy With a PARPi

Primary Source

Journal of Clinical Oncology

Source Reference:

ASCO Publications Corner

ASCO Publications Corner