Validation of a novel biomarker panel for the detection of ovarian cancer

Background: Ovarian cancer is the most lethal gynecological malignancy. Our integrated-omics approach to ovarian cancer biomarker discovery has identified kallikrein 6 (KLK6) and folatereceptor 1 (FOLR1) as promising candidates but these markers require further validation. Methods: KLK6, FOLR1, CA125, and HE4 were investigated in three independent serum cohorts with a total of 20 healthy controls, 150 benign controls, and 216 ovarian cancer patients. The serum biomarker levels were determined by ELISA or automated immunoassay. Results: All biomarkers demonstrated elevations in the sera of ovarian cancer patients compared with controls (P < 0.01). Overall, CA125 and HE4 displayed the strongest ability (AUC 0.80 and 0.82, respectively) to identify ovarian cancer patients and the addition of HE4 to CA125 improved the sensitivity from 36% to 67% at a set specificity of 95%. In addition, the combination of HE4 and FOLR1 was a strong predictor of ovarian cancer diagnosis, displaying comparable sensitivity (65%) to the bestperforming CA125-based models (67%) at a set specificity of 95%. Conclusions: The markers identified through our integrated-omics approach performed similarly to the clinically approved markers CA125 and HE4. Furthermore, HE4represents a powerful diagnostic marker for ovarian cancer and should be used more routinely in a clinical setting. Impact: The implications of our study are 2-fold: (i) we have demonstrated the strengths of HE4 alone and in combination with CA125, lending credence to increasing its usage in the clinic; and (ii) we have demonstrated the clinical utility of our integrated-omics approach to identifying novel serum markers with comparable performance to clinical markers.