CA 125: a misleading tumor marker?

International

Journal of Gynecology & Obstetrics 55 (1996) 179-180

Brief communication

CA 125: a misleading tumor marker? Dirk Schrijversa, Peter van Damb, Allan van Oosterom* a a Depatiment of Medical Oncology, Universily Hospital of Antwetp, Edegem, Belgium hDepatiment of Gynecology University Hospital of Antwerp, Edegem, Belgium

Received 23 May 1996; revised 9 July 1996; accepted 17 July 1996

Keywords:

Docetaxel; Side effects; CA 125; Ovarian cancer

Serum CA 125 is a useful tumor marker in the management of patients with ovarian cancer. It can predict the presence of residual disease more accurately than clinical and radiological examinations [l]. Nevertheless benign gynecologic conditions, ascites due to liver cirrhosis, pleural effusions or pericarditis may increase the level of CA 125. Docetaxel (Taxotere@) is an anti-neoplastic agent with activity in ovarian cancer. It has specific side effects, such as fluid retention with edema, pleural effusion and ascites [31. A 53-year-old woman with a mutinous cystadenocarcinoma of the ovary (FIG0 stage III) developed a supraclavicular lymph node metastasis 3 years after initial treatment. She received docetaxel and showed a partial response with a normalization of the CA 125 after 2 cycles. After the seventh cycle, she developed pedal edema and a pleural effusion. The level of CA ,125 increased despite the fact that the supraclavicular lymph node was hardly palpable. The treatment with docetaxel was stopped because of the toxicity,

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while tumor progression was suspected. Slowly the edema and the pleural effusion disappeared and the level of CA 125 normalized. After 6 months, the lymph node increased as did the CA 125. Three years after initial treatment, a 51-year-old woman developed a bowel obstruction due to relapse of a serous cyst adenocarcinoma of the ovary. She received 6 cycles of cisplatin, adriamycin and cyclophosphamide. Shortly thereafter disease progression with peritoneal me&stases and ascites was seen. The CA 125 was 1506 U/ml (normal value < 35 U/ml>. Second line treatment with docetaxel was initiated. After 6 cycles, there was a partial response with disappearance of the ascites, but a pleural effusion was noted. The CA 125 was 27 U/ml. She received a 7th cycle, after which the pleural effusion worsened, ascites reappeared and the CA 125 increased to 120 U/ml. The treatment was discontinued and the patient was followed without starting any other anti-cancer treatment. Six weeks after the discontinuation, the pleural effusion had resolved and the CA 125 normalized. The CA 125 remained normal until 9 months later. Then it increased

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again with the reappearance of peritoneal metastases. CA 125 may increase due to fluid retention by docetaxel without tumor progression. This fluid retention syndrome is seen in 60% of patients treated with docetaxel in a dose of more than 400 mg/m’ with development of ascites, pleural effusions or edema [3]. CA 125 should be used with caution as an indicator of tumor activity in patients treated with this drug.

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References [l]

[2]

[3]

Davis HW, Zurawski VR, Bast PC, et al. Charactertsation of the CA 125 antigen associated with epithelial ovarian cancer. Cancer Res 1986; 46: 6143. Jacobs I, Bast RC. The CA 125 tumour associated antigen: a review of the literature. Hum Reprod 1989: 4: l-12. Schrijvers D, Wanders J, Dirix L, Prove A. Vonck I, Van Oosterom A. Coping with toxicities of docetaxel (taxotere). Ann Oncol 1993; 4: 610-61 I.