Treatment of Advanced Ovarian Cancer, with Thomas Herzog, MD: Case 1

May 2015

• 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

April 2017

• 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.