Case Studies
Expert physicians provide insight on managing oncology-based patient cases that highlight the use of novel agents in clinical practice.
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Platinum-Resistant Advanced Ovarian Cancer
Platinum-Resistant Advanced Ovarian Cancer
Case: A 70-Year-Old Woman Presenting With Advanced Ovarian Cancer
H & P:
- A 70-year-old woman presents for evaluation of left-ovary mass discovered during a recent pelvic exam. She reports abdominal tenderness, urinary symptoms, and a “bloated” or “full” feeling, despite normal diet and bowel movements
- Postmenopausal, no children
- PE: reveals a woman of low normal weight (BMI = 19 kg/m2) with hypertension; abdomen is distended and shows dullness to percussion
- BP = 135/80 mm Hg on metoprolol
- Fasting glucose = 95 mg/dL
- LDL = 90 mg/dL
Imaging
- CT with contrast of pelvis, abdomen, and chest reveals multiple peritoneal lesions and spread to outside of liver
- Malignant ascites present
Biopsy and labs:
- Pathology: high-grade epithelioid adenosarcoma, ovarian primary
- BRCA1/2 status: unknown
- CA-125: 656 U/mL
Treatment
- She underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking; residual disease after cytoreduction: 1.25 cm
- Diagnosis: stage IV ovarian cancer, grade 3
- Started on carboplatin and paclitaxel plus bevacizumab; achieved a partial response
- She was continued on maintenance bevacizumab
Follow up:
- Follow up imaging at 6 months showed disease progression in the liver
- She was started on paclitaxel plus bevacizumab
