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Gynecologic Cancer Case Studies

Case Studies: A Case of Advanced Serous Ovarian Cancer

Expert David O’Malley, MD, reviews the diagnosis and treatment of a 69-year-old Caucasian woman who presents with advanced-stage ovarian cancer.

A Case of Advanced Serous Ovarian Cancer

Case: A 69-year-old Woman with Advanced Serous Ovarian Cancer

January 2017

  • A 69-year-old Caucasian woman presented to the emergency department with shortness of breath
  • PMH: mild HTN and DM, medically managed; morbid obesity
  • PE: large volume ascites
  • CT angiography (chest) showed large bilateral pulmonary effusions, no pulmonary thromboembolism
  • Laboratory findings remarkable for CA 125, 525U/mL
  • Thoracentesis (1500 cc); cytology showed high grade adenocarcinoma
  • Paracentesis (4500 cc); cytology showed high grade adenocarcinoma
  • Core biopsy of omentum; high grade serous carcinoma; p53 (+)/ PAX 8 (+) /WTI and CX 7 (+); BRCA1/2 wild-type
  • The patient underwent debulking surgery with incomplete cytoreduction
  • She was treated as part of a clinical trial with carboplatin/paclitaxel + bevacizumab followed by continuous bevacizumab maintenance

April 2018

  • Fifteen months later, the patients complained of severe abdominal bloating and fatigue
  • Imaging showed multifocal recurrence within the abdominal cavity
    • CA 125, 322 U/mL
    • ECOG 1
  • She was started on carboplatin/docetaxel
  • After 6 cycles of therapy she had a partial response to therapy with bulky residual disease
  • She was initiated on rucaparib maintenance therapy, 600 mg BID
  • Hb fell to 7.2 g/dl, managed with treatment interruption and then dose reduction to rucaparib 500 mg
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