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Serum HE4 Profile During Primary Chemotherapy of Epithelial Ovarian Cancer
  1. Johanna Hynninen, MD*,
  2. Annika Auranen, MD, PhD*,
  3. Kirsti Dean, MD,
  4. Maija Lavonius, MD, PhD,
  5. Olli Carpen, MD, PhD§,
  6. Antti Perheentupa, MD, PhD*,,
  7. Marko Seppänen, MD, PhD and
  8. Seija Grénman, MD, PhD*
  1. * Department of Obstetrics and Gynaecology, Turku University Hospital, University of Turku, Turku; Departments of
  2. Radiology, and
  3. Surgery, Turku University Hospital, Turku;
  4. § Department of Pathology, University of Turku and Turku University Hospital, Turku;
  5. Department of Physiology, Institute of Biomedicine, University of Turku; and
  6. Department of Nuclear Medicine, Turku PET Centre, Turku University Hospital, Turku, Finland.
  1. Address correspondence and reprint requests to Johanna Hynninen, MD, Department of Obstetrics and Gynaecology, Turku University Hospital, FI-20520 Turku, Finland. E-mail: johanna.hynninen{at}


Objective Human epididymis protein 4 (HE4) is a promising novel serum biomarker for the detection of early-stage epithelial ovarian cancer (EOC) and for the differential diagnosis between benign and malignant ovarian tumors. The objective of the present study was to determine the value of HE4 for monitoring the response to primary therapy in patients with advanced disease.

Methods Serum HE4 and cancer antigen (CA) 125 levels of 10 patients with advanced EOC and one patient with adenocarcinoma of unknown origin were measured preoperatively and during first-line chemotherapy. Seven patients were treated with primary surgery and six cycles of chemotherapy. Response to treatment was evaluated 4 weeks after the completion of chemotherapy using computed tomography. Four patients received neoadjuvant chemotherapy (NACT) before surgery. To evaluate the early response to chemotherapy, changes in serum biomarker levels were compared with metabolic changes of tumors during NACT as detected by positron emission tomography/computed tomography.

Results The profile of HE4 during primary chemotherapy was in line with radiologic and clinical responses. In the neoadjuvant chemotherapy group, HE4 correlated better with the radiologic response than CA 125.

Conclusion Assessment of serum HE4 may improve the reliability of response evaluation during chemotherapy for serous epithelial ovarian cancer.

  • Ovarian carcinoma
  • HE4
  • CA 125
  • Treatment response
  • PET/CT

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