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