Biomarker Testing for Ovarian Cancer: Clinical Utility of Multiplex Assays
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CURRENT OPINION
Biomarker Testing for Ovarian Cancer: Clinical Utility of Multiplex Assays Brian M. Nolen • Anna E. Lokshin
Published online: 4 April 2013 Ó Springer International Publishing Switzerland 2013
Abstract The improved detection of ovarian cancer at the earliest stages of development would confer a significant benefit in the therapeutic efficacy and overall survival associated with this devastating disease. The inadequate performance of currently used imaging modalities and the CA 125 biomarker test have precluded the establishment of screening programs and hindered the development of diagnostic tests for ovarian cancer. Two recently completed large clinical trials of ovarian cancer screening have reported findings of mixed impact, further clouding the issue. Considerable effort has been applied to the development of multiplexed biomarker-based tests and the most recent advances are discussed here. Within the clinical setting of pelvic mass differential diagnosis and triage, several significant advancements have been achieved recently, including the US Food and Drug AdministrationB. M. Nolen (&) A. E. Lokshin University of Pittsburgh Cancer Institute, Hillman Cancer Center, 5117 Centre Avenue 1.18, Pittsburgh, PA 15213, USA e-mail: [email protected] A. E. Lokshin e-mail: [email protected] A. E. Lokshin Department of Medicine, School of Medicine, University of Pittsburgh, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15213, USA A. E. Lokshin Department of Pathology, School of Medicine, University of Pittsburgh, S-417 BST, 200 Lothrop Street, Pittsburgh, PA 15261, USA A. E. Lokshin Department of Ob/Gyn, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, USA
approved Risk of Ovarian Malignancy Algorithm and OVA1 tests. The development and evaluation of those tests are described in this review. Thus while effective routine screening for ovarian cancer remains a lofty goal, advancement within the clinical management of pelvic mass diagnoses appears to be near at hand.
1 Introduction Ovarian cancer represents the eighth most common cancer among women and the second most frequently diagnosed gynecological malignancy in the USA and Europe [1]. The overall mortality attributed to ovarian cancer exceeds that of any other gynecological cancer with over 50 % of the more than 200,000 women newly diagnosed each year worldwide expected to perish from the disease [2]. A critical factor in the elevated mortality associated with ovarian cancer is the lack of disease-specific symptoms. Compounding the problem of ubiquitous clinical presentation is the observation that the majority of early-stage cancers are asymptomatic resulting in over three-quarters of all diagnoses being made at a time when the disease has already established regional or distant metastases [3]. Despite aggressive cytoreductive surgery and platinumbased chemotherapy, the 5-year survival rate for patients with clinically advanced ovarian cancer is only 15–20 %, although the cure rate for stage I disease is u
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