Dynamic analysis of serum Ca-125 levels during neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer: a retrospective study

Adarsh Dharmarajan, A. Remya, Aswathi Krishnan


Background: Assessment of CA-125 kinetics was commonly used as a tool for tumor response to chemotherapy in ovarian cancer patients. The study aimed to determine any logarithmic/linear relationship between pre-chemotherapy and pre-operative CA-125 levels in ovarian cancer.

Methods: Total 52 patients who underwent neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery were included. CA-125 levels before starting chemotherapy, during chemotherapy and the preoperative value, with the date of measurement recorded. Cox’s proportional hazards regression was used to evaluate univariate and independent multivariable association with the effect of clinical, pathological and CA-125 kinetic parameters on outcome endpoints.  

Results: The study couldn’t establish any relationship in logarithmic fall of CA-125 values among ovarian cancers as a result of neo-adjuvant chemotherapy. The disease-free survival among the patients was 12.2 months.

Conclusions: There is an inverse relationship between serum CA-125 levels and survival in ovarian cancer. NACT resulted in adequate fall of CA-125 levels in most of the patients, but the rate of fall was not predictive of prognosis.


CA-125, Neoadjuvant chemotherapy, Interval cytoreduction

Full Text:



International Agency for Research on Cancer. Cancer Today-Globocan. 2018. Available at: Accessed on 25 August 2020.

Vergote I, Coens C, Nankivell M, Kristensen GB, Parmar MKB, Ehlen T, et al. Neoadjuvant chemotherapy versus debulking surgery in advanced tubo-ovarian cancers: pooled analysis of individual patient data from the EORTC 55971 and CHORUS trials. Lancet Oncol. 2018;19(12):1680–7.

3Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.

Rustin GJ, Nelstrop AE, McClean P, Brady MF, McGuire WP, Hoskins WJ, et al. Defining response of ovarian carcinoma to initial chemotherapy according to serum CA 125. J Clin Oncol. 1996;14(5):1545–51.

Riedinger JM, Eche N, Basuyau JP, Dalifard I, Hacene K, Pichon MF. Prognostic value of serum CA 125 bi-exponential decrease during first line paclitaxel/platinum chemotherapy: A French multicentric study. Gynecol Oncol. 2008;109(2):194–8.

Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival Effect of Maximal Cytoreductive Surgery for Advanced Ovarian Carcinoma During the Platinum Era: A Meta-Analysis. J Clin Oncol. 2002;20(5):1248–59.

Høgdall E. Cancer antigen 125 and prognosis. Curr Opin Obstet Gynecol. 2008;20:4–8.

O’Brien TJ, Beard JB, Underwood LJ, Dennis RA, Santin AD, York L. The CA 125 gene: An extracellular superstructure dominated by repeat sequences. Tumor Biol. 2001;22(6):348–66.

Burger RA, Darcy KM, DiSaia PJ, Monk BJ, Grosen EA, Gatanaga T, et al. Association between serum levels of soluble tumor necrosis factor receptors/CA 125 and disease progression in patients with epithelial ovarian malignancy: A gynecologic oncology group study. Cancer. 2004;101(1):106–15.

Bast RC, Klug TL, John ES, Jenison E, Niloff JM, Lazarus H, et al. A Radioimmunoassay Using a Monoclonal Antibody to Monitor the Course of Epithelial Ovarian Cancer. N Engl J Med. 1983;309(15):883–7.

Colaković S, Lukiç V, Mitroviç L, Jeliç S, Susnjar S, Marinkoviç J. Prognostic value of CA125 kinetics and half-life in advanced ovarian cancer - PubMed. Int J Biol Markers. 2000;15(2):147–52.

Chi DS, Venkatraman ES, Masson V, Hoskins WJ. The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma. Gynecol Oncol. 2000;77(2):227–31.

Cooper BC, Sood AK, Davis CS, Ritchie JM, Sorosky JI, Anderson B, et al. Preoperative CA 125 levels: An independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol. 2002;100(1):59–64.

Wilbaux M, Hénin E, Oza A, Colomban O, Pujade-Lauraine E, Freyer G, et al. Dynamic modeling in ovarian cancer: An original approach linking early changes in modeled longitudinal CA-125 kinetics and survival to help decisions in early drug development. Gynecol Oncol. 2014:460–6.

Herzog TJ, Vermorken JB, Pujade-Lauraine E, Provencher DM, Jagiello-Gruszfeld A, Kong B, et al. Correlation between CA-125 serum level and response by RECIST in a phase III recurrent ovarian cancer study. Gynecol Oncol. 2011;122(2):350–5.

Chiang AJ, Chen J, Chung YC, Huang HJ, Liou WS, Chang C. A longitudinal analysis with CA-125 to predict overall survival in patients with ovarian cancer. J Gynecol Oncol. 2014;25(1):51–7.