Clinical dilemmas arise after first-line therapy—what follow-up protocol is appropriate and when should second-line therapy be instituted? All patients have serial CA125 estimations but as soon as the marker rises, much anxiety is caused and many patients expect treatment. There is no evidence that treating simply because of a rising CA125 is of benefit, and because second-line therapy is not very effective within 12 months of previous treatment, there is good reason to try and withhold chemotherapy until patients are either symptomatic or have measurably progressive disease on imaging or clinical examination. An MRC-EORTC study is addressing this important issue, randomizing patients with a rising CA 125 to immediate second-line therapy or delayed treatment.

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