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, BRCA 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 2024 SGO Winter Meeting. 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.