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. 2020 Dec;29(12):2504-2512.
doi: 10.1158/1055-9965.EPI-20-1057. Epub 2020 Oct 13.

Biomarkers and Strategies for Early Detection of Ovarian Cancer

Robert C Bast Jr  1 , Zhen Lu  2 , Chae Young Han  2 , Karen H Lu  3 , Karen S Anderson  4 , Charles W Drescher  5 , Steven J Skates  6
Affiliations

Biomarkers and Strategies for Early Detection of Ovarian Cancer

Robert C Bast Jr et al. Cancer Epidemiol Biomarkers Prev. 2020 Dec.

Abstract

Early detection of ovarian cancer remains an important unmet medical need. Effective screening could reduce mortality by 10%-30%. Used individually, neither serum CA125 nor transvaginal sonography (TVS) is sufficiently sensitive or specific. Two-stage strategies have proven more effective, where a significant rise above a woman's baseline CA125 prompts TVS and an abnormal sonogram prompts surgery. Two major screening trials have documented that this strategy has adequate specificity, but sensitivity for early-stage (I-II) disease must improve to have a greater impact on mortality. To improve the first stage, different panels of protein biomarkers have detected cases missed by CA125. Autoantibodies against TP53 have detected 20% of early-stage ovarian cancers 8 months before elevation of CA125 and 22 months before clinical diagnosis. Panels of autoantibodies and antigen-autoantibody complexes are being evaluated with the goal of detecting >90% of early-stage ovarian cancers, alone or in combination with CA125, while maintaining 98% specificity in control subjects. Other biomarkers, including micro-RNAs, ctDNA, methylated DNA, and combinations of ctDNA alterations, are being tested to provide an optimal first-stage test. New technologies are also being developed with greater sensitivity than TVS to image small volumes of tumor.See all articles in this CEBP Focus section, "NCI Early Detection Research Network: Making Cancer Detection Possible."

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Conflict of interest statement

Conflicts of interest: Dr. Bast receives royalties from Fujirebio Diagnostics Inc. for the discovery of CA125. Massachusetts General Hospital co-licensed the Risk of Ovarian Cancer Algorithm to Abcodia Inc. and Dr. Skates is a consultant to Abcodia.

Figures

Figure 1.
Figure 1.
Serial pattern of CA125 levels in six women from a UK study prospective trial of 22,000 postmenopausal women. CA125 values for three women with occult ovarian cancer (red dots) and three women without ovarian cancer (green dots).
Figure 2.
Figure 2.
Two stage screening strategy using the Risk of Ovarian Cancer Algorithm (ROCA).
Figure 3.
Figure 3.
Serial CA125 values for 4 patients from the NROSS who presented with early stage ovarian cancer.
Figure 4.
Figure 4.
Cumulative ovarian cancer deaths. In the UKCTOCS trial. HR=hazard ratio. MMS=multimodal screening.
See this image and copyright information in PMC

References

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