Dr Smith on Next Steps With the KELIM Score and HIPEC in Epithelial Ovarian Cancer

Gabriella Smith, MD, obstetrician/gynecologist, Cleveland Clinic, discusses next steps for a retrospective study evaluating the predictive value of CA-125 ELIMination Rate Constant K (KELIM) for survival outcomes with hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of surgery in patients with epithelial ovarian cancer.

This retrospective study examined cases from 2017 to 2022, specifically focusing on patients with advanced, high-grade serous ovarian cancer treated with neoadjuvant chemotherapy followed by HIPEC during interval cytoreductive surgery. Using Cox univariate and multivariate regression, investigators calculated progression-free survival (PFS) and overall survival (OS) outcomes, although the low event count in multivariate regression led investigators to predominantly present data from the univariate analyses. This analysis encompassed 63 patients, with age, 

 mutation status, prior neoadjuvant chemotherapy cycles, and chemotherapy responses evenly distributed between groups.

Notably, patients with a KELIM score of 1 or higher demonstrated a reduced incidence of radical hysterectomies. Those with a favorable KELIM score exhibited prolonged PFS, with a median follow-up of 29.9 months (95% CI, 16.3-38.0) for all patients. The median PFS for the favorable KELIM group was 19.7 months compared with 12.3 months for the unfavorable group, and the favorable group had a higher 3-year OS rate at 79.9% (95% CI, 65.5%-94.4%) vs 43.6% (95% CI, 20.9%-66.4%) in the unfavorable group, confirming the anticipated outcomes based on background data.

Smith and colleagues presented this information in a poster at the 

. Moving forward, investigators will expand this dataset and compare the KELIM score among patients receiving HIPEC during interval debulking vs those who do not, Smith reports. Although further data accumulation is necessary to firmly establish the utility of the KELIM score, this score holds promise as a prognostic tool for identifying optimal candidates for HIPEC, she explains. Despite limitations, the findings from this small, retrospective analysis align with those from prior studies, reinforcing the potential of the KELIM score as a prognostic indicator in the neoadjuvant chemotherapy and HIPEC settings, Smith concludes.

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Gabriella Smith, MD, discusses the predictive value of KELIM for survival outcomes with HIPEC at the time of surgery in epithelial ovarian cancer.

Gabriella Smith, MD, discussed the predictive value of CA-125 KELIM score for survival outcomes with HIPEC during surgery in epithelial ovarian cancer.

Dr Smith on the Rationale for Investigating the Predictive Utility of CA-125 KELIM Score in Ovarian Cancer

Gabriella Smith, MD, obstetrician/gynecologist, Cleveland Clinic, discusses the rationale for launching a retrospective study which evaluated the predictive value of CA-125 ELIMination Rate Constant K (KELIM) for survival outcomes with hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of surgery in epithelial ovarian cancer.

Smith and colleagues shared information from the study at the SGO 2024 Winter Meeting

. In the study, the predictive value of KELIM score for progression-free survival (PFS) and overall survival (OS) outcomes was assessed in a specific cohort of patients undergoing neoadjuvant chemotherapy prior to interval debulking surgery, Smith begins. The study aimed to extend the understanding of the KELIM score's applicability in patients who underwent HIPEC during their interval debulking surgery. A particular focus was placed on individuals diagnosed with high-grade serous ovarian cancer, a subgroup in which the KELIM score has been previously validated, she explains. This retrospective study included 63 patients from the Cleveland Clinic's HIPEC database undergoing neoadjuvant chemotherapy followed by HIPEC and interval cytoreductive surgery between 2017 to 2022, Smith emphasizes.

Patients were required to have advanced high-grade serous ovarian cancer, and have had at least 3 CA-125 levels within 100 days of initiating neoadjuvant chemotherapy to accurately calculate the KELIM score, Smith says.

Patients without the requisite CA-125 data were excluded, along with patients with non-high-grade serous histology, and those who were lost to follow-up, she continues. Additional consideration was given to patients who were referred specifically for interval debulking and HIPEC but did not undergo neoadjuvant or adjuvant therapy at the Cleveland Clinic, as their follow-up data would not be accessible in the institutional database, she explains. Cox univariate and multivariate regression was employed to analyze collective data. However, the scarcity of events in the multivariate regression limited any meaningful interpretation of data, Smith states. Consequently, investigators primarily focused on data from the univariate analyses, shedding light on the association between the KELIM score, HIPEC, and the survival outcomes in the context of advanced high-grade serous ovarian cancer, she concludes.

Dr Smith on the Predictive Value of CA-125 KELIM Score For Outcomes With HIPEC in Ovarian Cancer

Gabriella Smith, MD, obstetrician/gynecologist, Cleveland Clinic, discusses key findings from a retrospective study evaluating the predictive value of CA-125 ELIMination Rate Constant K (KELIM) score for survival outcomes with hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of surgery in patients with epithelial ovarian cancer.

The single-institution study compared progression-free survival (PFS) and overall survival (OS) outcomes in patients undergoing HIPEC at time of interval cytoreductive surgery who had an unfavorable pre-HIPEC KELIM score (<1) vs a favorable KELIM ( ≥ 1), Smith begins. Between 2017-2022, 63 patients with primary advanced high grade serous ovarian cancer undergoing neoadjuvant chemotherapy followed by HIPEC at time of interval cytoreductive surgery from the Cleveland Clinic's HIPEC database were included in the evaluation, Smith details.

Results from the study were presented at the 

2024 Society of Gynecologic Oncology Winter Meeting

, and confirmed that CA-125 KELIM score was predictive of PFS and OS for this patient population, Smith states. Patients with an unfavorable KELIM score were more inclined to undergo modified radical hysterectomy rather than simple hysterectomy during interval debulking surgery (14.8% vs. 0%). However, other surgical procedures did not exhibit significant differences (

At a median duration of follow-up of 29.9 months (95% CI, 16.3-38.0) for all patients, the median progression-free survival (PFS) for all patients was 15.2 months, while overall survival (OS) was 39.1 months, Smith reports. Notably, patients with a favorable KELIM score had a significantly longer median PFS of 19.7 months compared with 12.3 months for those with an unfavorable score, she adds. Median OS was not reached in patients with a favorable KELIM score, with a significantly higher OS rate of 79.9% at 3 years (95% CI, 65.5-94.4). Conversley, the OS rate was 43.6% (95% CI, 20.9-66.4) in patients with an unfavorable score, Smith states.

Overall, findings were consistent with previous studies which found that KELIM score was predictive of PFS and OS in patients with epithelial ovarian cancer undergoing neoadjuvant chemotherapy, Smith concludes.

Gabriella Smith, MD, discusses the predictive value of CA-125 KELIM score for outcomes with HIPEC during surgery in patients with epithelial ovarian cancer.
 

Gabriella Smith, MD

Articles

Dr Smith on Next Steps With the KELIM Score and HIPEC in Epithelial Ovarian Cancer

Dr Smith on the Rationale for Investigating the Predictive Utility of CA-125 KELIM Score in Ovarian Cancer

Dr Smith on the Predictive Value of CA-125 KELIM Score for Outcomes With HIPEC in Ovarian Cancer