More often than not patients and many physicians believe that an early start of chemotherapy treatment may stifle ovarian cancer, decrease the rate of mortality and overall improve quality of life in women with the disease. However, a study based on a unique randomised trial focused particularly on treatment timing, shows that this is not necessarily true. There seems to be equal response to early treatment in comparison to commencing treatment when relapse symptoms are obvious. An article in The Lancet – Cancer Special Issue, explains these items in detail.

The focal point of the study was CA125 testing. CA125 is a protein produced by ovarian cancer cells in the blood and often levels increase several months before signs of relapse become evident. There is much debate among professionals as to when these level tests are done and when responsive radiation treatment should commence. Aside, CA125 testing and results can cause patients to panic without cause in some instances.

Authors of this study state:

Women should be informed that there is no evidence of a benefit from early treatment on the basis of rising CA125 concentration, and no deterioration in quality of life by delaying chemotherapy. If CA125 concentration rises during follow-up, chemotherapy can be safely delayed until symptoms or signs of tumour recurrence develop.

The Medical Research Council (MRC) OV05 and European Organisation for Research and Treatment of Cancer (EORTC) 55955 trials were conducted to compare the benefits of early treatment compared to prescribing chemotherapy post confirmation of relapse.

Women enrolled voluntarily in a trial to look further into this debate. 1,442 women with ovarian cancer in full remission took part. Exams and a CA125 test were conducted every quarter. If CA125 levels doubled, patients were randomly assigned to early (treatment starting as soon as possible) or delayed (treatment starting when signs or symptoms of relapse were detected) chemotherapy. Finally, a total of 529 women, 265 to early treatment and 264 to delayed therapy were followed and observed.

After a follow up of between nine and 56 months, no difference in overall survival was shown between early and delayed treatment. Unfortunately, 370 women died, almost equally from each group: 186 in the early treatment group, 184 in the delayed group. Survival rates also were even, median survival after randomisation was 25•7 months for patients having early treatment and 27•1 months for those having delayed treatment.

In an interesting finding, quality of life (QOL) ratings deteriorated sooner in patients being treated earlier. Key QOL points had significant dips in emotional, social, and fatigue assessments.

In conclusion, the researchers say:

For the first time women can be given evidence-based advice and can make informed choices about follow-up.. The results of this trial suggest that they can opt to forgo routine CA125 monitoring if their disease is in complete remission after first-line treatment.

Robert Morris from Wayne State University in Detroit and Bradley Monk from Creighton University School of Medicine in Arizona adds:

This clinical trial should be appreciated for its bold challenge to the assumption that early treatment of relapsed disease must be better than delayed treatment. Indeed, the article provides some evidence that early retreatment might be detrimental. Rustin and colleagues should be commended on this endeavour, which, like other provocative studies, begs more questions than it answers. From their study, principles that we have considered fundamental are deservedly brought into question.

“Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial”
Prof Gordon JS Rustin MD, Maria EL van der Burg MD, Clare L Griffin MSc, David Guthrie FRCR, Alan Lamont FRCR, Prof Gordon C Jayson FRCP, Gunnar Kristensen MD, César Mediola MD, Corneel Coens MSc, Wendi Qian PhD, Prof Mahesh KB Parmar DPhil, Dr Ann Marie Swart MD
The Lancet, Volume 376, Issue 9747, Pages 1155 – 1163, 2 October 2010
doi:10.1016/S0140-6736(10)61268-8

Written by Sy Kraft (B.A.)