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Gynecologic Cancer Case Studies

Case Studies: Clinical Approach for Platinum-Sensitive Recurrent Ovarian Cancer

In this case-based interview, Bradley J. Monk, MD, FACOG, FACS, reviews the case of a 40-year-old Caucasian female patient who presents with platinum-sensitive recurrent ovarian cancer and the treatment approach for this type of patient.

Clinical Approach for Platinum-Sensitive Recurrent Ovarian Cancer

Platinum-Sensitive Recurrent Ovarian Cancer

September 2014

  • A 40-year old Caucasian female presented to her gynecologist with abdominal pain and increased urinary urgency and frequency
    • PMH: unremarkable
    • FH: mother died of breast cancer at age 46
    • PE: tenderness in abdominal right lower quadrant; shifting dullness on abdominal palpation and percussion
    • Ultrasound: Abdominal and pelvic ultrasound showed a right-sided solid pelvic mass and ascites
  • The patient was then referred to a gynecologic oncologist
    • Genetic testing was positive for BRCA1 mutation
    • Abdominal/pelvic CT findings showed a 5-cm x 2.5 cm x 3-cm right pelvic mass; ascites and omental cake was noted
    • CA125, 998 U/mL
  • Biopsy findings showed stage 3C epithelial ovarian cancer
  • Hysterectomy, bilateral salpingo-oophorectomy, and omentectomy was performed and optimal debulking was achieved (residual disease <1 cm)
  • Treatment was initiated with IV/IP carboplatin/paclitaxel
    • After 6 cycles of therapy, CA-125 level declined to 9.3 U/ml.
    • Chemotherapy was tolerated well and without any unexpected toxicities

November 2016

  • The patient reported feeling bloated and exhausted
  • CT scan confirmed disease recurrence with ascites
  • She was treated with carboplatin/paclitaxel/bevacizumab for 6 cycles and had a good response to therapy
  • Following completion, she was continued on maintenance bevacizumab
  • She continued to show improved response

January 2018

  • The patient reported back with complaints of weight loss and abdominal distension
  • CT scan revealed presence of small diffuse intraperitoneal masses
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