Pitfalls of CA-125 Levels in the Preoperative Work-Up of Ovarian Masses

importance. The relevant issue is that these patients had experiencedtreatment failure after these standard cytotoxic therapies. Given thatmost patients had received all three drugs, there would be little basisforusingdegreeofpriortherapyasastratificationfactor.Itshouldalsobe noted that these patients were a select population who had main-tainedanEasternCooperativeOncologyGroupperformancestatusof0 or 1 after having progressed through oxaliplatin-based andirinotecan-basedregimens.Assuch,extrapolationofthesedatatolessmedicallyfitpatientsmustbedonewithconsiderablecaution.I agree, and we stated in the manuscript, that our trial is ahypothesis-generatingphaseIIstudy,andassuch,Idonotfeelthatitconstitutes a basis for a change in routine, standard practice. Thewritersoftheletterstatethatthesedatawouldbepractice-changingifconfirmedinaphaseIII;however,itshouldbenotedthattherewillbenophaseIIIiterationofthisnon–first-linestudy,becausesuchatrialisnolongerfeasibleduetotheroutinepracticeofusingbevacizumabinfirst-line treatment in those parts of the world where bevacizumab isused,aswellastotheemergingdatathatwild-typeK-rasisnecessaryalthough not sufficient for antitumor activity of an anti–epidermalgrowthfactorreceptormonoclonalantibody.Ourstudywasdesignedtotestthesafetyandfeasibilityofconcurrenttherapywithcetuximabandbevacizumab,andtoserveasasafetypilotforthecurrentCancerand Leukemia Group B/Southwest Oncology Group 80405 first-linedual monoclonal antibody plus combination chemotherapy study,whichiscurrentlyaccruingpatients.