Ovarian cancer biomarkers: current state and future implications from high-throughput technologies

Ovarian cancer remains the most lethal gynecological malignancy worldwide and survival rates have remained unchanged in spite of medical advancements. Much research has been dedicated to the identification of novel biomarkers for this deadly disease, yet it has not been until recently that a few serum-based tests have been added to carbohydrate antigen 125 as Food and Drug Administration-approved tests for ovarian cancer. This lack of success in identifying clinically relevant biomarkers has been largely attributed to poor study design and bias leading to false discoveries or identification of second-tier biomarkers. Fortunately, a better understanding of the guidelines used to assess the clinical utility of a biomarker and the various phases of biomarker development will aid in avoiding such biases. As well, advances in high-throughput technologies have caused a renewed interest in biomarker discovery for ovarian cancer using alternative strategies such as targeted sequencing and proteomics. In this chapter, we will review the current state of ovarian cancer biomarker research with a focus on diagnostic serum markers. Furthermore, we will examine the standard practice guidelines' criteria for acceptance of a biomarker into the clinic as well as emerging high-throughput approaches to the discovery of novel ovarian cancer biomarkers.