Case: A 58-Year-Old Female With Progressive Ovarian Cancer
H & P
A 58-year-old female presents to the clinic for bloating, pelvic pain, early satiety, and urinary urgency. She reports intolerance to strenuous activity at the gym for the past four months but is still able to carry out daily activities such as work, and house chores.
PE: controlled HTN, abdominal distension;
BP: 130/70 mmHg
ECOG: 1
Imaging
CT with contrast of the pelvis, abdomen, and chest reveals bilateral serous cystadenocarcinomas
Biopsy and Labs
Pathology: high-grade serous carcinoma, epithelial ovarian cancer
BRCA1-/2wt
HRD/+
CA-125: 280 U/mL
Treatment
Diagnosis: stage IV ovarian cancer
Patient underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking
Received IV paclitaxel and carboplatin and bevacizumab, 6 cycles
Follow-up
CA-125, 43 U/mL upon completion of 6 cycles chemotherapy
Ten months later at routine follow up, patient presented with recurring symptoms; CA-125, 565 U/mL
Started on carboplatin/paclitaxel for 6 cycles plus bevacizumab
Patient achieved a partial response, started on niraparib maintenance therapy
Four months later:
CBC: WNL, SCr: 0.8, AST: 10 u/L, ALT: 7 u/L, and ANC: 1.7 x 109/L