A new bone marrow test for patients diagnosed with ovarian cancer may help determine which patients are at the greatest risk for a cancer recurrence. This may help to more appropriately define initial treatment regimens, according to a recent article published in the
Journal of Clinical Oncology.
Ovarian cancer is a common malignancy occurring in the United States, with about 25,000 new cases diagnosed each year. It is the major cause of death from gynecologic malignancy in Europe and the United States. The ovary makes female hormones and stores all of the eggs that are released once a month during ovulation. There are two ovaries, one on each side of the uterus. Treatment options depend on the stage, or extent of disease, but may include surgery, chemotherapy, radiation therapy and/or biologic therapy (treatment utilizing the body’s immune system to fight cancer). Following initial treatment, many patients experience a cancer recurrence, which is responsible for the high death rates associated with this cancer. This has led researchers to evaluate new ways to predict a patient’s risk of recurrence, so that those at a higher risk may receive additional or innovative treatments to help prevent a cancer recurrence. Patients at a lower risk may be spared from unnecessary treatment.
Doctors believe that one of the early sites that becomes involved with ovarian cancer is the bone marrow (spongy material inside large bones responsible for producing blood cells). A relatively new test, called the cytokeratin (CK) test, can detect the presence of ovarian cancer cells in the bone marrow. This is because cytokeratin is a protein that binds to small molecules present on the surface of ovarian cancer cells.
A recent clinical trial was conducted to evaluate the effectiveness of a CK bone marrow test in predicting the risk of a cancer recurrence in patients with ovarian cancer. Following diagnosis, patients with clinical stages I, II, or III ovarian cancer (cancer confined to the abdomen), had a sample of bone marrow tested for CK positive cells. They were then treated with standard therapy according to their stage.
Distant recurrences (outside the abdomen) were diagnosed in nearly 60% of patients who had CK-positive cells in their bone marrow. Conversely, only 3% of patients who did not have CK-positive cells in their bone marrow were later diagnosed with distant recurrences. The rate of survival with no distant recurrences was 35% for patients with a positive bone marrow test and 95% for patients with a negative bone marrow test. Moreover, almost 90% of patients diagnosed with distant recurrences had a positive bone marrow test upon diagnosis.
These results suggest that bone marrow testing may help predict which patients with ovarian cancer are at a higher risk for a cancer recurrence. More aggressive treatment or participation in a clinical trial may be warranted for the highest-risk patients in order to help prevent recurrences and improve survival. In addition, patients at a lower risk may require less treatment and may be spared from the side effects associated with aggressive therapy.
Patients with ovarian cancer may wish to speak with their physician regarding the risks and benefits of participating in a clinical trial further evaluating this test or other promising treatment strategies. Two sources of information regarding ongoing clinical trials involve comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) andeCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (Journal of Clinical Oncology, Vol 19, No 2, pp 368-375, 2001)