Browsing by Author "Reed, Nicholas"

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    The strong prognostic value of KELIM, a model-based parameter from CA 125 kinetics in ovarian cancer: Data from CALYPSO trial (a GINECO-GCIG study)
    (Academic Press Inc Elsevier Science, 2013)
    You, Benoit
    ;
    Colomban, Olivier
    ;
    Heywood, Mark
    ;
    Lee, Chee
    ;
    Davy, Margaret
    ;
    Reed, Nicholas
    ;
    Pignata, Sandro
    ;
    Varsellona, Nenzi
    ;
    Emons, Guenter  
    ;
    Rehman, Khalid
    ;
    Steffensen, Karina Dahl
    ;
    Reinthaller, Alexander
    ;
    Pujade-Lauraine, Eric
    ;
    Oza, Amit M.
    Background. Unexpected results were recently reported about the poor surrogacy of Gynecologic Cancer Intergroup (GCIG) defined CA-125 response in recurrent ovarian cancer (ROC) patients. Mathematical modeling may help describe CA-125 decline dynamically and discriminate prognostic kinetic parameters. Methods. Data from CALYPSO phase III trial comparing 2 carboplatin-based regimens in ROC patients were analyzed. Based on population kinetic approach, serum [CA-125] concentration-time profiles during first 50 treatment days were fit to a semi-mechanistic model with following parameters: "d[CA-125] / dt = (KPROD exp (BETA t)) Effect - KELIM [CA-125]" with time, t; tumor growth rate, BETA; CA-125 tumor production rate, KPROD; CA-125 elimination rate, KELIM and K-dependent treatment indirect Effect. The predictive values of kinetic parameters were tested regarding progression-free survival (PFS) against other reported prognostic factors. Results. Individual CA-125 kinetic profiles from 895 patients were modeled. Three kinetic parameters categorized by medians had predictive values using univariate analyses: K; KPROD and KELIM (all P < 0.001). Using Cox multivariate analysis, 5 independent predictors of PFS remained significant: GCIG CA-125 response (favoring carboplatin-paclitaxel arm), treatment arm, platinum free-interval, measurable lesions and KELIM (HR = 0.53; 95% CI 0.45-0.61; P < 0.001). Conclusions. Mathematical modeling of CA-125 kinetics in ROC patients enables understanding of the time-change components during chemotherapy. The contradictory surrogacy of GCIG-defined CA-125 response was confirmed. The modeled CA-125 elimination rate KELIM, potentially assessable in routine, may have promising predictive value regarding PFS. Further validation of this predictive marker is warranted. (c) 2013 Elsevier Inc. All rights reserved.