First-Line PARPi Maintenance in Advanced Ovarian Cancer - Episode 1

A 54-Year-Old Female With Ovarian Cancer

Wendel Naumann, MD:Today we’re presented with a case of a 54-year-old woman who presents with typical ovarian cancer syndromes with pain and bloating. She has an elevated CA-125 [cancer antigen 125] and a CT [computed tomography] scan shows about a 3-cm mass on the ovary. There is no ascites or pleural effusions, so it looks like it is localized. She undergoes an exploratory laparotomy but unfortunately has an unresectable 1.2-cm mass.

She then goes on to receive 3 cycles of IV [intravenous] chemotherapy with paclitaxel and carboplatin and undergoes a secondary cytoreductive surgery. This time all gross residual disease is removed.

Germline molecular testing shows a pathogenic mutation inBRCA1. At that point, she is switched to IV/IP [intraperitoneal] paclitaxel and cisplatin and completes 3 more cycles of chemotherapy. Prior to her chemotherapy she had a CA-125 of 48 [U/mL], before the interval cytoreductive surgery, which goes down to 20 after the surgery. At this point, she’s started on niraparib maintenance therapy.

In follow-up after completion of her chemotherapy, her CA-125 is 25 [U/mL]. The CT scan at 2-and-a-half months after surgery says no gross residual disease. The chest CT scan is unremarkable, and her pelvic exam is unremarkable, and she has a good performance status.

Transcript edited for clarity.


Case: A 54-Year-Old Female With Ovarian Cancer

H & P

  • 54-year-old female presents with abdominal pain and bloating
    • Pathology: High-grade, stage III, epithelial ovarian cancer of the right ovary, and positive for numerous small (<0.7cm) pelvic and para-aortic lymph nodes disease
    • CA-125, 305 U/mL
  • Imaging
    • CT with contrast of the pelvis, abdomen, and chest revealed a right adnexal 2.9-cm mass, no ascites or pleural effusion noted
  • Treatment
    • Patient underwent exploratory laparotomy with unilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection
      • Status post-surgery: macroscopic residual disease (R2), 1.2cm lesion
      • Received second cytoreduction surgery
    • Germline molecular testing showed HRD +,BRAC1alteration
    • Initiated IV/IP paclitaxel/cisplatin
    • Initial post treatment CA 125, 48 U/mL
    • Started on niraparib maintenance therapy
  • Follow-up:
    • CA 125, 25 U/mL upon completion of chemotherapy (6 cycles)
    • CT at 2.5 months post-surgery, no gross pelvic masses; chest CT unremarkable
    • Unremarkable pelvic exam
    • ECOG: 0