Abstract Recent work suggests that a 2-stage strategy incorporating serial measurements of the glycoprotein CA125 in patient serum and the Risk of Ovarian Cancer Algorithm (ROCA), followed by transvaginal ultrasound for women with high-risk scores, may have utility as a screening practice in the general population. However, CA125 only has a sensitivity of 50-60% for early stage disease, and is only present in approximately 80% of all ovarian cancers. Multiple marker panels have shown promise at increasing sensitivity and specificity over CA125 alone, but have not improved lead time for early cancer detection. Therefore, we have taken an unbiased in-depth approach to identify novel plasma biomarkers to complement CA125 in ovarian cancer early detection. Using high-resolution quantitative mass spectrometry, we have profiled the plasma proteome of preclinical patient samples, taken 1 year prior to CA125 elevation and diagnosis, and healthy controls from the Normal Risk Ovarian Screening (NROS) study. With this approach, we have identified over 30 biomarker candidates that are elevated in at least 50% of preclinical samples relative to controls in triplicate experiments, including cancer-specific post-translational modifications. As a means of preliminary validation of promising preclinical biomarkers, we have profiled the plasma proteome of 24 newly diagnosed, early stage ovarian cancer patients and 24 matched healthy controls. Further, half of these patients were selected with uninformative CA125 levels at diagnosis, allowing for the discovery of additional candidate biomarkers that may complement CA125. Correlation of preclinical and newly diagnosed patient plasma data with publicly available genomic and transcriptomic data, as well as proteomic data previously collected from ovarian cancer cell lines resulted in a prioritized list of candidate protein biomarkers and autoantibodies in patient plasma that may improve detection and lead time over CA125. For the most promising candidates, monoclonal antibodies and MagPlex assays are being optimized in order to determine their performance as useful biomarkers in additional patient sera. Multimarker panels will be tested in a training set for the development of a screening algorithm that will be evaluated in preclinical sera to determine the optimized set that improves detection and lead time over CA125. Citation Format: Clayton Boldt, Ph.D., Archana Simmons, Ph.D., Hong Wang, MS, Ph.D., Keith Baggerly, Ph.D., Robert Bast, Jr., M.D., Samir Hanash, M.D., Ph.D.. Integrating genomics, transcriptomics, and proteomics for the discovery of novel biomarkers to complement CA125 in ovarian cancer early detection [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr AS12.