First-Line PARPi Maintenance in Advanced Ovarian Cancer

Case: A 54-Year-Old Female With Ovarian Cancer

H & P

• 54-year-old female presents with abdominal pain and bloating
  • Pathology: High-grade, stage III, epithelial ovarian cancer of the right ovary, and positive for numerous small (<0.7cm) pelvic and para-aortic lymph nodes disease
  • CA-125, 305 U/mL
• Imaging
  • CT with contrast of the pelvis, abdomen, and chest revealed a right adnexal 2.9-cm mass, no ascites or pleural effusion noted
• Treatment
  • Patient underwent exploratory laparotomy with unilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection
    • Status post-surgery: macroscopic residual disease (R2), 1.2cm lesion
    • Received second cytoreduction surgery
  • Germline molecular testing showed HRD +,BRAC1alteration
  • Initiated IV/IP paclitaxel/cisplatin
  • Initial post treatment CA 125, 48 U/mL
  • Started on niraparib maintenance therapy
• Follow-up:
  • CA 125, 25 U/mL upon completion of chemotherapy (6 cycles)
  • CT at 2.5 months post-surgery, no gross pelvic masses; chest CT unremarkable
  • Unremarkable pelvic exam
  • ECOG: 0