Clinical presentation of relapse in a cohort of patients (pts) with complete response to initial treatment of advanced epithelial ovarian cancer (EOC)

Abstract

5048 Background: Most pts with advanced EOC experience complete response following initial surgery and platinum/taxane based chemotherapy; however, disease recurrence is common. Subsequent interventions are typically palliative. An optimal postreatment surveillance strategy to has not been established. This report evaluates the relapse patterns in a cohort of pts recently participating in a randomized phase II consolidation trial with oregovomab vs placebo [Berek JCO 22:3507]. Methods: Clinical outcomes for a cohort of 145 pts with stage III/IV EOC were assessed for the role of physical examination, CT scan and CA125 in the diagnosis of relapse. Results: 98 of 145 pts (68%) experienced clinical relapse during the observation period. Relapse was identified by physical exam in only 19% of cases (17 pelvic findings, 2 non-pelvic) and by CT in absence of physical findings in 75%. 2 pts were diagnosed on a second look laporatomy and one patient on incidental surgery. CA125, which was not used for diagnosis of relapse in the clinical trial, was in the normal range at relapse in 34 pts (35%), although all had originally presented with CA125 elevation. CA125 values were reduced or unchanged for 5% of pts, while 30% experienced at least a doubling of CA125 in the three month interval preceding relapse. 84% of pts with abnormal physical findings had elevated CA125. Of those without elevated CA125, recurrence was diagnosed on CT scan in 32 pts (91%). Conclusions: The clinical presentation of relapse in EOC is diverse, and reliance on any single diagnostic modality is unreliable. Pelvic findings were commonly accompanied by elevation of CA125, whereas occult perihepatic and retroperitoneal metastases were more commonly associated with normal CA125. Optimal posttreatment patient surveillance involve careful use of multiple modalities. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Unither