Panagiotis Tzitzis

The Role of Delayed Interval Debulking Surgery (DIDS) in the Surgical Treatment of Advanced Epithelial Ovarian Cancer: A Retrospective Cohort from an ESGO-Certified Center

Background/Objectives: Patients with advanced ovarian cancer with a high tumor burden typically undergo neoadjuvant chemotherapy (NACT) followed by interval debulking surgery. The optimal number of NACT cycles remains undefined: although three to four cycles are considered gold-standard, in real-world practice, five or more cycles are frequently administrated. This study aims to evaluate the impact of delayed interval debulking surgery (DIDS) after ≥5 cycles of NACT on the survival rates. Methods: We conducted a retrospective analysis of women with advanced ovarian cancer that underwent surgery in the 1st Department of Obstetrics–Gynecology Clinic from 2012 to 2022. Patient characteristics, oncological, and follow-up information were collected. Results: A total of 125 patients met the inclusion criteria and were divided into two groups: Group A (77 patients) received 3–4 of NACT cycles, and Group B (48 patients) ≥5 cycles. No statistically significant difference was observed between the groups concerning age, BMI, comorbidities, Aletti score, FIGO stage, pre-operative CA-125 values, surgery duration, rate of postoperative complications, hospital stay, ICU admittance, and complete gross resection (RD = 0). However, patients undergoing DIDS experienced significantly greater intraoperative blood loss. Progression-free survival did not differ between groups (IDS: 17 vs. DIDS: 18 months, p = 0.561), whereas overall survival was significantly lower in the DIDS group (IDS: 52 vs. DIDS: 36 months, p = 0.00873). This statistical significance persisted after controlling for residual disease, but was lost after adjusting for FIGO stage. Conclusions: DIDS may be considered for advanced ovarian cancer patients with a high tumor burden, when complete gross resection (RD = 0) cannot be achieved during IDS. Further prospective randomized trials are necessary to evaluate its oncological safety and morbidity.

CA-125 KELIM as an Alternative Predictive Tool to Identify Which Patients Can Benefit from PARPi in High-Grade Serous Advanced Ovarian Cancer: A Retrospective Pilot Diagnostic Accuracy Study

BRCA mutation and homologous recombination deficiency (HRD) are the criteria for the administration of PARP inhibitor (PARPi) maintenance therapy. It is known that PARPi efficacy is related to platinum sensitivity and that the latter can be demonstrated from the CA-125 elimination rate constant (KELIM). This study aims to investigate if KELIM can be another tool in the identification of patients that could be benefit from PARPi therapy. Retrospective analysis of patients with high-grade serous advanced ovarian cancer that underwent cytoreduction and was further tested for HRD status. The HRD status was tested either by myChoice HRD CDx assay or by RediScore assay. KELIM score was measured in both neoadjuvant and adjuvant settings with the online tool biomarker-kinetics.org. A total of 39 patients had available data for estimating both HRD status and KELIM score. When assuming KELIM as a binary index test with the value 1 as the cut-off point, the sensitivity was 0.86, 95% CI (0.64–0.97) and the specificity was 0.83, 95% CI (0.59–0.96). On the other hand, when assuming KELIM as a continuous index test, the area under the curve (AUC) was 81% and the optimal threshold, using the Youden index, was identified as 1.03 with a sensitivity of 85.7% and a specificity of 83.3%. KELIM score seems to be a new, cheaper, and faster tool to identify patients that can benefit from PARPi maintenance therapy.