ONCAlert | 2017 San Antonio Breast Cancer Symposium
Gynecologic Cancer Case Studies

Case Studies: Treatment of Advanced Ovarian Cancer, with Thomas Herzog, MD

In this case-based interview, Thomas Herzog, MD, provides an overview on the therapeutic management for a patient who presents with recurrent advanced ovarian cancer.

Treatment of Advanced Ovarian Cancer, with Thomas Herzog, MD: Case 1

May 2015

  • A 56-year-old woman presented to her gynecologist with urinary frequency and persistent abdominal bloating. The patient reports maintaining normal activities and a moderate exercise.
    • PMH: Hypertension, well-controlled or spironolactone
    • Abdominal ultrasound showed a complex mass in the right pelvis measuring 4.5 X 5.0 X 7.5 cm
    • Physical exam: fluid wave test positive for ascites
    • CA-125, 622 U/ml
  • She was referred to a gynecologic oncologist for further evaluation.
  • CT of the pelvis and abdomen showed a right complex pelvic mass, ascites, and omental cake. No other peritoneal lesions were visualized.
  • Based on CT findings, she was scheduled for surgery.
  • The patient underwent complete resection with no residual disease remaining.
  • Diagnosis, epithelial ovarian cancer, stage IIIC
  • She received 6 cycles of carboplatin every 3 weeks (AUC 6) and weekly paclitaxel (80 mg/m2) for 18 weeks.
  • Follow up labs showed normalization of CA-125 to less than 10 U/ml

April 2017

  • Almost 2 years later, the patient reported having symptoms of persistent abdominal distention and weight loss. She reports feeling tired and napping during the day.
    • CA-125 level, 330 U/ml
    • CT scan showed peritoneal seeding consistent with carcinomatosis
  • Diagnosis: platinum-sensitive recurrent ovarian cancer
  • The patient was started on bevacizumab (15 mg/kg) plus 6 cycles of carboplatin (AUC 5) and paclitaxel (175 mg/m2) every 3 weeks with a plan for bevacizumab maintenance therapy.
  • After 2 cycles of therapy, she developed grade 2 hypertension (156/94 mm Hg); this was subsequently controlled by adding an ACE inhibitor to her diuretic.
  • The patient has continued therapy without incident.
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