ESMO Asia Congress 2022

Abstract 192P

Background

Neoadjuvant chemotherapy is the best option for most epithelial ovarian cancers as they present in stage III & IV.The important determinants of survival in ovarian cancer include complete cytoreduction and response to platinum based chemotherapy . HE4, a novel biomarker was found to be better predictor of optimal cytoreduction and platinum sensitivity compared to CA 125 which has low sensitivity and specificity in premenopausal women. This study is done to assess the role of serum marker HE4 in predicting response to chemotherapy in epithelial ovarian cancer.

Methods

This is a prospective observational study of 39 patients in the age group 25-75yrs with newly diagnosed epithelial ovarian cancer/primary peritoneal carcinoma planned for neo adjuvant chemotherapy. Patients with renal failure and other cancers which can cause HE4 elevation were excluded. Tumour markers CA125 and HE4 were measured at baseline, before each cycle of chemotherapy and before surgery. Imaging with CECT abdomen was done at the end of neo adjuvant chemotherapy. The prediction of response by the tumour markers were assessed.

Results

Most patients were postmenopausal with high grade serous adenocarcinoma histology, in advanced stage(FIGO 3 or 4). Tumour markers did not predict radiological outcomes. Optimal cytoreduction(R0-≤ 1cm residual disease) was achieved in 66.7%. Neither CA125 nor its reduction with chemotherapy was predictive of surgical outcome. HE4 at the end of NACT and its reduction with chemotherapy was predictive of optimal cytoreduction. HE4 cut off of 275pmol/L at the end of NACT had 77% sensitivity and 85% specificity to predict poor surgical outcome. Reduction in HE4 with chemotherapy was a predictor of pathological response. Table: 192P

	Baseline	Cycle 1	Cycle 2	Cycle 3	End of NACT
Marker	CA 125	HE 4	CA 125	HE 4	CA 125	HE 4	CA 125	HE 4	CA 125	HE 4
%Reduction (R+)			43	30	73	55	83	66	86	71
%Reduction (R0)			48	48	75	73	86	86	88	88
p-value			>0.05	<0.01	>0.05	<0.01	>0.05	<0.01	>0.05	<0.01
R+	1924.95	2121.6	911.45	1321	281.23	833.6	168.45	580.3	164.33	522.0
R0	1470.66	2366.8	813.34	1147.7	330.1	562.5	153.73	287.1	126.22	172.3
p-value	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	>0.05	<0.01

Conclusions

HE4 is a better predictor of response to therapy in patients undergoing neo adjuvant chemotherapy. HE4 value at the end of NACT and percentage reduction with each cycle can predict optimal cytoreduction after neo adjuvant chemotherapy.