Elecsys® HE4 - Human epididymal protein 4

A biomarker for the management of ovarian cancer patients

Human epididymal protein 4 (HE4) is a biomarker that is highly elevated in epithelial ovarian cancer and has been shown to be involved in ovarian cancer cell proliferation and invasion.^1-3

HE4 has a higher sensitivity and specificity than CA125 in the detection of ovarian cancer in patients presenting with pelvic mass.⁴

Among women presenting with pelvic mass, the combined use of HE4 and CA 125 using ROMA (Risk of Ovarian Malignancy Algorithm) can increase the sensitivity and specificity of risk estimation of patients with pelvic mass - even stages I/II ovarian cancer – than CA 125 alone^5-7

In addition, HE4 can be used for monitoring disease and progression.^8-10

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Risk of Ovarian Malignancy Algorithm (ROMA)

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Pelvic mass evaluation: Risk of Ovarian Malignancy Algorithm (ROMA)
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PI = - 12.0 + 2.38LN[HE4] + 0.0626LN[CA125]		PI = -8.09 + 1.04LN[HE4] + 0.732LN[CA125]
▼		▼
ROMA* index [%] = exp(PI) / [1 + exp(PI)] *100
▼		▼
< 11.4%	≥ 11.4 %	< 29.9 %	≥ 29.9 %
low risk	high risk	low risk	high risk

Clinical benefit #1:

Among women presenting with pelvic mass, a combined use of HE4 and CA 125 using ROMA (Risk of Ovarian Malignancy Algorithm) can increase the sensitivity and specificity - even stages I/II ovarian cancer – as compared to testing CA 125 alone

ROMA accurately identifies 94% of the patients with pelvic mass as having ovarian cancer⁵
ROMA has a higher sensitivity than CA 125 alone: Among ten women with ovarian cancer, ROMA identifies one more patient than CA 125 alone (sensitivity: ROMA 90% vs. CA 125 79%)⁶
ROMA has a higher specificity than CA 125 alone: Among ten women with benign gynecologic diseases, ROMA dismisses one more patient which CA125 alone would include as having ovarian cancer (Specificity: ROMA 93% vs. CA 125 86%)⁶
ROMA has a higher sensitivity and specificity in detecting stages I/II ovarian cancer than CA 125 alone⁷

Clinical benefit #2:

HE4 and CA 125 together improve ovarian cancer monitoring.

Either HE4 or CA 125 levels can be elevated in patients during therapy monitoring and recurrence monitoring^8-10
At disease progression, some patients show an elevated HE4 level earlier than an increase in CA 125 level, and others show an elevated CA 125 level earlier than an increase in HE4 level. Therefore, HE4 and CA 125 together can effectively monitor therapy response^8-10
As patients with elevated CA 125 level at diagnosis can switch to elevated HE4 level at follow up, and vice versa, testing for both HE4 and CA 125 can identify patients with recurrent disease that CA 125 alone would miss¹⁰

Technical benefit:

Efficiency and reliability for the laboratory

Shows excellent precision across the entire measuring range for reliable results
Has 28 days of stability at 2-8^˚C after opening
Is fast with 18 minute assay time
Is available for use in both serum and plasma

Consolidation of 17 tumor marker assays is available on one automated platform.