Treatment of Advanced Ovarian Cancer, with Thomas Herzog, MD: Case 1
Treatment of Advanced Ovarian Cancer, with Thomas Herzog, MD
- A 56-year-old woman presented to her gynecologist with urinary frequency and persistent abdominal bloating. The patient reports maintaining normal activities and a moderate exercise.
- PMH: Hypertension, well-controlled or spironolactone
- Abdominal ultrasound showed a complex mass in the right pelvis measuring 4.5 X 5.0 X 7.5 cm
- Physical exam: fluid wave test positive for ascites
- CA-125, 622 U/ml
- She was referred to a gynecologic oncologist for further evaluation.
- CT of the pelvis and abdomen showed a right complex pelvic mass, ascites, and omental cake. No other peritoneal lesions were visualized.
- Based on CT findings, she was scheduled for surgery.
- The patient underwent complete resection with no residual disease remaining.
- Diagnosis, epithelial ovarian cancer, stage IIIC
- She received 6 cycles of carboplatin every 3 weeks (AUC 6) and weekly paclitaxel (80 mg/m2) for 18 weeks.
- Follow up labs showed normalization of CA-125 to less than 10 U/ml
- Almost 2 years later, the patient reported having symptoms of persistent abdominal distention and weight loss. She reports feeling tired and napping during the day.
- CA-125 level, 330 U/ml
- CT scan showed peritoneal seeding consistent with carcinomatosis
- Diagnosis: platinum-sensitive recurrent ovarian cancer
- The patient was started on bevacizumab (15 mg/kg) plus 6 cycles of carboplatin (AUC 5) and paclitaxel (175 mg/m2) every 3 weeks with a plan for bevacizumab maintenance therapy.
- After 2 cycles of therapy, she developed grade 2 hypertension (156/94 mm Hg); this was subsequently controlled by adding an ACE inhibitor to her diuretic.
- The patient has continued therapy without incident.