Platinum-Resistant Advanced Ovarian Cancer

Case: A 70-Year-Old Woman Presenting With Advanced Ovarian Cancer

H & P:

• A 70-year-old woman presents for evaluation of left-ovary mass discovered during a recent pelvic exam. She reports abdominal tenderness, urinary symptoms, and a “bloated” or “full” feeling, despite normal diet and bowel movements
• Postmenopausal, no children
• PE: reveals a woman of low normal weight (BMI = 19 kg/m²) with hypertension; abdomen is distended and shows dullness to percussion
  • BP = 135/80 mm Hg on metoprolol
  • Fasting glucose = 95 mg/dL
  • LDL = 90 mg/dL

Imaging

• CT with contrast of pelvis, abdomen, and chest reveals multiple peritoneal lesions and spread to outside of liver
• Malignant ascites present

Biopsy and labs:

• Pathology: high-grade epithelioid adenosarcoma, ovarian primary
• BRCA1/2status: unknown
• CA-125: 656 U/mL

Treatment

• She underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking; residual disease after cytoreduction: 1.25 cm
• Diagnosis: stage IV ovarian cancer, grade 3
• Started on carboplatin and paclitaxel plus bevacizumab; achieved a partial response
• She was continued on maintenance bevacizumab

Follow up:

• Follow up imaging at 6 months showed disease progression in the liver
• She was started on paclitaxel plus bevacizumab