Survival was about the same in both groups: 25.7 months in those who were treated early and 27.1 months in those treated later, the researchers reported.
But many of the patients in the study relapsed earlier than average, suggesting that they might have higher-risk disease, meaning one more resistant to chemotherapy, said Dr. Robert A. Burger, professor of surgical oncology and director of the Women's Cancer Center at Fox Chase Cancer Center in Philadelphia.
"In this therapy-resistant subgroup, it may be reasonable to hold off on treatment until patients become symptomatic or to treat with a non-toxic agent, such as tamoxifen, or to enroll such patients in a clinical trial evaluating biologic therapies rather than cytotoxics," he said. "This trial has not answered the question for patients who relapse at 12 months or later."
Burger also pointed out there are differences in patterns of care and the availability of a wider range of drugs to treat ovarian cancer in the United States than in Europe on average. Also, treatments have improved since the study was conducted.
In the study, however, quality of life was found to be much higher among those who started chemo only after symptoms of the cancer's recurrence, something Berchuck has seen in his own practice.
"I've had patients with CA125 levels going up and I know it, but I try to tell them we can't cure cancer and there's no evidence that treating sooner is better so they should just stay on a chemo holiday with the knowledge that they will have to go back at some point. They'll have improved quality of life," he explained.
Berchuck said he himself would rather know CA125 levels, even if women don't want the results passed on, "so I know what's going on with the disease. The key thing is not the CA125 levels, it's what you do with the information."
All rights reserved