Chemosensitivity may predict PFS after first-line treatment in ovarian cancer
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KELIM, a model-based parameter from CA-125 kinetics, was an independent prognostic factor of progression-free survival for 5 years after first-line treatment in patients with ovarian cancer, according to data presented at ESMO Virtual Congress 2020.
“Based on data from more than 5,000 patients, we know that KELIM is an indicator of the tumor primary chemosensitivity,” Benoit You, MD, PhD, of Lyon University Hospital, Lyon, France, said in his presentation. “The objective was to assess the role of KELIM regarding the likelihood of long progression-free survivorship of more than 5 years after first line treatment.”
Researchers analyzed datasets from three phase 3 trials in adjuvant setting (AGO-OVAR 9, AGO-OVAR 7 and ICON 7) to determine the prognostic role of KELIM regarding the probability of PFS in 2,868 patients with stage I through IV ovarian cancer. As a validation dataset, they used an independent population-based cohort of 1,582 patients in a neo-adjuvant setting.
Of those in the adjuvant setting, 82 patients (2.8%) were progression-free: 48 stage 1-2 (likelihood of PFS = 9.5%); 32 stage 3 (likelihood of PFS = 1.6%); two stage 4 (likelihood of PFS = 0.5%) over a median follow-up of 45 months, according to the abstract.
With favorable KELIM, the researchers reported that the likelihood of PFS increased to 12% for patients with stage 1 to 2, 2.9% for patients with stage 3 and 2.1% for patients with stage 4 ovarian cancer. Multivariable logistic regression analysis indicated that higher FIGO stage (stage 3: OR = 0.18; stage 4: OR = 0.06) and KELIM (OR = 2.35; 95% CI, 1.51-3.59) predicted PFS.
Of those in the neo-adjuvant setting, 36 patients (2.7%) were progression-free: two stage 2 (likelihood of PFS = 22.2%); 26 stage 3 (likelihood of PFS = 2.8%); eight stage 4 (likelihood of PFS = 1.2%) over a median follow-up of 95 months.
With favorable KELIM, the likelihood of PFS increased to 5.4% for patients with stage 3 and 2.4% for patients with stage 4 ovarian cancer, according to the results.
Analysis indicated that completing interval debulking surgery (OR = 6.25; 95% CI, 2.4-21.41) and KELIM (OR = 3.82; 95% CI, 1.49-9.65) predicted PFS. You and colleagues reported that likelihood of PFS was 12% for stage 3 patients with favorable KELIM and complete surgery.
Moreover, analysis of an explorative set of 509 patients demonstrated that the KELIM prognostic impact was more marked in patients with BRCA wild-type and BRCA1 mutation than in those with BRCA2 mutation.“This study suggests that the likelihood of disease cure in first-line setting is a result of three complementary covariates,” You said. “The disease stage and feasibility of complete debulking surgery are already known. But, also the tumor primary chemosensitivity, which should probably be integrated in the disease management algorithms in first-line settings.”
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You B, et al. Abstract 815MO. Presented at: European Society for Medical Oncology Virtual Congress 2020; Sept. 19-21, 2020.
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