The timing of normalization of CA-125 levels during primary chemotherapy is predictive of survival in patients with epithelial ovarian cancer.

OBJECTIVE: To determine if the timing of normalization of CA-125 levels during primary chemotherapy for epithelial ovarian cancer (EOC) could predict survival. METHODS: Patients who reached a complete clinical response for EOC with primary taxane/platinum-based chemotherapy were eligible. Patient demographics, chemotherapy administration, CA-125 levels, and survival outcomes were abstracted. Progression free survival (PFS), overall survival (OS), and platinum sensitivity (>6 months from chemotherapy completion) were compared to CA-125 levels during primary therapy. RESULTS: 262 patients who achieved a complete clinical response were identified. Patients who achieved normalization of CA-125 by 3rd cycle of chemotherapy were compared to patients who failed to achieve normalization by the 3rd cycle. Patients with early normalization demonstrated improved PFS (19 vs. 6 months; p<0.001), OS (48 vs. 27 months; p<0.001) and platinum sensitivity (78 vs. 22%; p<0.001). This survival advantage was maintained when patients were evaluated by debulking status. Additionally, when stratified by the specific cycle patients' achieved normalization, PFS ranged from 25 months after surgery to 2 months after 6th cycle (p<0.001). OS demonstrated a similar trend from 74 months to 22 months (p<0.001), while platinum sensitivity decreased from 72% to 24% (p<0.001). An average of 3.8 months in PFS and 8.6 months of OS was gained for each one-cycle improvement in CA-125 normalization. CONCLUSION: Earlier normalization of CA-125 levels during primary chemotherapy for EOC predicts improvement in platinum sensitivity, PFS, and OS. This data provides prognostic information that may influence future decisions regarding chemotherapy and potentially earlier enrollment in treatment protocols.

The effect of obesity on survival in patients with ovarian cancer.

OBJECTIVE: Data has suggested obesity as an independent prognostic factor for lower survival in patients with epithelial ovarian cancer (EOC). We sought to determine if obesity portends a disadvantage to surgical outcomes at the time of initial surgery affecting survival. METHODS: A retrospective chart review of patients diagnosed with EOC was performed. All patients underwent primary cytoreductive surgery followed by taxane/platinum-based chemotherapy. Patient demographics, surgicopathologic and survival data were evaluated. Patients were compared based on body mass index (BMI) (<30 vs. > or =30) and BMI strata (underweight, normal weight, overweight, obese and morbidly obese). Survival analyses were performed with the Kaplan Meier method and compared using the log rank test, chi(2) test, and Fischer's exact test. RESULTS: 304 patients were identified. 71 patients (23%) were obese (BMI>30). The groups were similar in regard to stage, grade, histology, and chemotherapy administered. In regard to surgical outcomes, no difference was seen in estimated blood loss (EBL), operating room (OR) time, or operative complications excluding wound complications. Optimal debulking rates were similar in obese and non-obese patients (52% vs. 51% respectively, p=0.88). There was no statistical difference in progression free survival (17 vs. 11 months) or overall survival (48 vs. 40 months) between the two groups or across BMI strata. CONCLUSION: Although obesity has been reported as an independent prognostic factor for survival, this data demonstrates that survival rates are similar between obese and non-obese patients when optimal debulking statuses are the same. Therefore, maximal effort should be directed towards optimal debulking obese patients with EOC.

Chemotherapy-related myelosuppression as a marker of survival in epithelial ovarian cancer patients.

OBJECTIVE: Authors have suggested that chemotherapy-induced neutropenia could represent a surrogate parameter of cancer stem cell response to treatment. Thus, the aim of this study was to evaluate the association of relative chemotherapy-induced neutropenia with survival in advanced epithelial ovarian cancer (EOC). METHODS: A computerized database identified patients for primary advanced EOC with 6 cycles of platinum-taxane-based chemotherapy. Data collected included demographics, chemotherapy administration, laboratory evaluation, and survival outcomes. Relative neutropenia, defined as an absolute neutrophil count (ANC) <1000/mm3 at chemotherapy cycle nadir, was evaluated and correlated to PFS, OS, and platinum sensitivity (recurrence >6 months from completion of chemotherapy). RESULTS: 255 patients were identified. Patients with neutropenia (n=203) during treatment were similar to patients who never had neutropenia (n=52) in regards to age, race, body mass index (BMI), stage, histology, grade, and debulking status. Neutropenic patients demonstrated improvements in PFS (14 vs. 6 months; p=0.01), OS (45 vs. 29 months; p=0.03) and platinum sensitivity rates (69% vs. 44%; p=0.001). As the number of neutropenic episodes increased, improvements in PFS (range 6 to 17 months; p=0.07) and platinum sensitivity (range 44% to 90%; p=0.002) was demonstrated. When stratified by debulking status, neutropenia conferred a survival advantage in suboptimally debulked patients, but only demonstrated marginal improvements in optimally debulked patients. CONCLUSIONS: Our data demonstrates that patients with chemotherapy-induced neutropenia is associated with a survival advantage in ovarian cancer, especially in suboptimally debulked patients.