Krishnansu S. Tewari, MD, FACOG, FACS: Options to Controlling Recurrent Metastatic Disease


Krishnansu S. Tewari, MD, FACOG, FACS says that s

ince this patient is platinum-sensitive, options include cisplatin, carboplatin, or oxaliplatin combined with either gemcitabine, pegylated liposomal doxorubicin, or topotecan. Although not FDA-approved for platinum- sensitive patients, bevacizumab at 15 mg/kg has been shown to improve PFS in platinum-sensitive patients in the OCEANS study when combined with carboplatin plus gemcitabine. Since she has had a long disease-free interval of 3 years and appears on imaging to only have surface liver metastasis and a solitary splenic nodule, a consideration for laparoscopy could be entertained with plans to perform a secondary cytoreductive surgery with or without heated intraperitoneal chemotherapy if limited disease is indeed encountered.

CASE 1: Epithelial Ovarian Cancer

Sarah W. is a 62-year-old Caucasian woman who works as a travel agent.

In June of 2013, the patient presented with bloating and abdominal distension. Prior medical history is notable for nulliparity, and medication-controlled hypertension.

  • Physical exam revealed palpable, fixed nodular 10-cm pelvic mass with abdominal ascites, and patient’s CA-125 level was 895 U/mL
  • She underwent total abdominal hysterectomy, bilateral salpingo oophorectomy, omentectomy, low anterior resection with anastomosis and complete cytoreduction of all gross metastatic disease. There was no gross residual disease. Stage was FIGO 3C epithelial ovarian cancer
  • Patient was negative forBRCA1or2mutation
  • She received 6 IV q3-week cycles of paclitaxel/carboplatin
  • Her symptoms resolved and CA-125 levels decreased to 9 U/mL; she remained disease free for approximately 18 months

In December of 2014, the patient presents for her 6-month evaluation with rising CA-125 level, mild abdominal distension and fatigue, and inability to work.

  • CT scanning reveals metastatic involvement of liver surface, an isolated splenic lesion, and a small amount of ascites
  • She was retreated with carboplatin/paclitaxel
  • Patient showed improvement in symptoms and performance status (ECOG 0) after 3 cycles of therapy
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