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Gynecologic Cancer Case Studies

Case Studies: A Case of Platinum-Sensitive Epithelial Ovarian Cancer

Expert Shannon Westin, MD, reviews the diagnosis and treatment of a 49-year-old African American woman who presents with advanced-stage epithelial ovarian cancer.

A Case of Platinum-Sensitive Epithelial Ovarian Cancer

A 49-Year-Old Woman with Platinum-Sensitive Epithelial Ovarian Cancer and Germline BRCA1 Mutation

March 2013

  • A 49-year-old African American woman presented to her primary care physician complaining of abdominal bloating
  • PMH: chronic HBV infection, mild HTN
  • FH: mother died of breast cancer at age 59, cousin on mother’s side died of ovarian cancer at age 65
  • CT, ascites and bilateral 8-cm adnexal masses
  • CA 125, 285 U/mL
  • She underwent exploratory laparotomy followed by omentectomy, bilateral salpingo-oophorectomy, pelvic lymph node dissection, appendectomy, and resection of pelvic nodules
    • No gross residual disease (R0)
    • Germline molecular testing showed a BRCA1 alteration
  • Pathology: high grade epithelial ovarian cancer involving omentum, both ovaries, and 3 micro-metastatic lymph nodes
  • She was treated with IV/IP paclitaxel/cisplatin; after completion, CA 125, 14.2, clinically NED

September 2015

  • 18 months later, on routine follow up, CA 125, 203 U/mL
  • Lymph node disease and carcinomatosis on imaging  
  • She was treated with gemcitabine/carboplatin for 6 cycles
    • CA 125, 11.3; clinically NED
  • The patient was started on rucaparib maintenance therapy while enrolled on a clinical trial
  • After 2 cycles of therapy, the patient’s live enzymes rose transiently and then returned to normal
    • AST, 127 U/L
    • ALT, 142 U/L
    • Creatinine, 1.5 mg/d            

November 2017

  • The patient complained of worsening fatigue and bloating
  • CA 125, 1004 U/mL
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