views and opinions expressed therein are those of the authors alone. They do not necessarily reflect the views or positions of
the Editor or of the American Society of Clinical Oncology.
usefulbloodtestsformonitoring
responsetotheinitialtherapyfor
ovariancancer.However,thevalueof
CA125levelstofollowpatientswhoare
inclinicalremissionafterfirst-linechemo-
therapyrecentlyhasbeenchallengedin
astudyconductedbyGordonJ.S.Rustin,
MD,MBBS,andcolleaguespresentedat
the2009ASCOAnnualMeeting.Itiswell
knownthatinmostpatientstheCA125
levelstendsonaveragetoriseseveral
physicalorradiologicsignsofrecurrence,
buttheeffectonsurvivalofthetimingof
re-initiationofchemotherapyhasbeen
unclear.InDr.Rustin'strial,patientswere
randomlyselectedtohaveCA125levels
monitoredforbiochemicalrelapseversus
usingotherclinicalsignsofrecurrence,
andeachofthesesignswerethenused
toinitiatesecond-linechemotherapy.On
average,theCA125levelsrose5to6
monthspriortoothersignsofdisease
recurrence.Theauthorsreportedthat
improvedbyinitiatingearliersecond-line
chemotherapybasedonlyontherising
CA125levels.Theyrecommendedthat
theroutinepracticeofmonitoringof
CA125levelsinthesewomenwithovar-
iancancerinclinicalremissioncouldbe
modified--acontroversialapproach.Itis
unclearhowthisstudywillbeappliedclini-
cally,andStanleyB.Kaye,MD,andMartin
E.Gore,MD,PhD,discusstheissuesthat
affecttheseimportanttherapeuticdeci-
sionsinovariancancer.
ProfessorandChair,DepartmentofObstetrics&Gynecology
StanfordUniversitySchoolofMedicine
Director,Women'sCancerProgram,DivisionofGynecologicOncology
StanfordCancerCenter
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