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.

The Use of CA-125 KELIM to Identify Which Patients Can Achieve Complete Cytoreduction after Neoadjuvant Chemotherapy in High-Grade Serous Advanced Ovarian Cancer.

(1) Background: Neoadjuvant chemotherapy followed by interval debulking surgery is used in the treatment of advanced ovarian cancer. However, no tool can safely predict if complete cytoreduction after 3-4 cycles can be achieved. This study aims to investigate if the KELIM score can be a triage tool in the identification of patients that will be ideal candidates for interval debulking surgery (IDS). (2) Methods: We retrospectively analyzed the records of patients with high-grade serous advanced ovarian cancer that were treated in the 1st Department of Obstetrics-Gynecology, 2012-2022, with neoadjuvant chemotherapy followed by IDS. Patient characteristics, oncological outcome and follow-up information were collected. The primary outcome was the association of the KELIM score with residual disease. (3) Results: 83 patients were categorized into two groups: Group A (51 patients) with favorable (≥1) and Group B (32 patients) with unfavorable (<1) KELIM scores. A statistically significant correlation between KELIM and residual disease (p < 0.05) exists, showing that patients with a favorable KELIM score can achieve a complete IDS. Furthermore, there was a statistically significant difference in overall survival (p = 0.017), but no difference was observed in progression-free survival (p = 0.13); (4) Conclusions: KELIM seems to safely triage patients after neoadjuvant chemotherapy and decide who will benefit from IDS.

Erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a case report.

The Erector Spinae Plane Block (ESP) is a novel regional technique for anesthesia or analgesia. Originally the ESP block was described in 2016 in a case report regarding analgesia intervention for a case of thoracic neuropathic pain. Since then, there has been growing interest and research adding experience about the ESP block as regional anesthetic and analgesic technique. Reviewing the literature about this novel technique in databases like PubMed using the key words "erector spinae plane block" returns approximately 56 publications. So far there is no available big series of cases or reviews regarding the ESP block. The literature is limited to case reports or case series. With the present case we are interested in exploring the efficacy of ESP block as a postoperative analgesic method for laparoscopic cholecystectomy. We describe the case of a 76-year-old female patient scheduled for laparoscopic cholecystectomy. Written informed consent was granted (for procedure and publication of photos). We applied a bilateral ultrasound-guided ESP block at T6 level while the patient was awake before general anesthesia induction. The anesthetic solution we used consisted of 12 mL Ropivacaine 0.375% plus 2 mg dexamethasone (on each side). After the successful administration of the block (observation of the solution spread between transverse process and the erector spinae muscles), general anesthesia was induced and the procedure was started. Procedure and recovery was uneventful with the patient experiencing very good analgesia (NRS pain score 0 up to 6 hours after block placement). The patient presented mild pain (NRS score of 2-3) after 6 hours and requested the "on demand" pain medication (1 g paracetamol IV) only 10 hours after the ESP block (NRS pain score of 4-5). The patient experienced no nausea or vomiting, was mobilized easily about 6 hours after the block and was discharged the next day. This relatively simple and safe block dramatically reduced the amount of IV pain medication we usually administer for the specific procedure. The overall result was increased satisfaction of the patient and avoidance of opioid use.