CA-125 monitoring in gynecologic cancer patients with COVID-19: A case series (413)

Objectives: CA-125 has long been utilized as a marker for gynecologic malignancies but can be elevated in many other inflammatory conditions, including lung disease. A retrospective study of tumor markers in non-cancer patients saw a rise in CA-125 values during severe COVID-19 infections. Similarly, a case report published on June 17, 2020, described a significant rise in CA-125 values during an ovarian cancer patient’s COVID-19 infection without evidence of disease progression. Given the potential confounding effect this could have on surveillance and treatment planning, we sought to describe the impact of COVID-19 infections on CA-125 trends in a gynecologic oncology patient population. Methods: We conducted a retrospective chart review of patients treated at a UPMC hospital during the COVID-19 pandemic from March 2020 through July 2021. Patients were included for analysis if they had a confirmed gynecologic malignancy, a COVID-19 infection, and had more than one CA-125 value drawn. The CA-125 values were plotted against the timeline of their COVID-19 infections to assess for trends in CA-125 values during and after infection. Results: There were 78 individuals identified with a COVID-19 infection and a CA-125 drawn following their positive COVID-19 test. Of these 78 patients, 18 had both gynecologic malignancy and more than one CA-125 drawn. Of these 18 patients, only one had an appreciable rise in their CA-125 values at the time of their COVID-19 diagnosis that resolved following their infection and could not be attributed to disease progression. Four patients were diagnosed with cancer at the time of COVID-19 diagnosis and had elevated CA-125 values. One patient passed before receiving treatment, and the other three had CA-125 values that trended down as they received treatment for their cancer. Two patients were noted to have a mild rise in their CA-125 at the time of their COVID-19 infection that continued to rise as they were diagnosed with the progression of their cancer. Most of the 18 patients (n=11, 61.1%) did not show an increase in CA-125 coinciding with their COVID-19 infection. They had either stable or decreasing CA-125 at the time of and following their COVID-19 diagnosis. Conclusions: This case series illustrates that while CA-125 values may increase during acute COVID-19 infection, cancer remains the most likely cause of a CA-125 increase. Clinical suspicion should remain high for a possible change in cancer status.