Role of human epididymis protein 4 (HE4) as predictor of response to platinum based chemotherapy: a systematic review of literature

Objective: Although epithelial ovarian cancer (EOC) treatment has greatly improved over the last three decades, a fraction of patients (40-60%) with advanced-stage disease fail to completely respond to standard therapy, because of chemo-resistance to platinum. For this reason, new predictive and monitoring tools were studied to identify platinum resistant EOC patients, with the purpose of improving and personalizing the treatment. In this review, we aim to discuss the latest evidence reported in the literature about the use of Human Epididymis 4 (HE4) to predict platinum resistance among EOC patients. Methods: A comprehensive search of the literature was conducted using the terms "HE4 epithelial ovarian cancer" and "human epididymis protein 4 epithelial ovarian cancer" and they were combined with the terms "chemotherapy", "platinum" and "response". Results: The search identified twelve papers, from January 1952 to December 2019, in line with eligibility criteria for this systematic review, all of which demonstrated good performance of HE4 in predicting platinum sensitivity or resistance. Conclusions: All the available studies present limited and non-homogeneous data, therefore more studies are needed to validate and reinforce the role of HE4 in predicting the response to platinum based chemotherapy among ovarian cancer patients.