Leslie Randall, MD, MAS, presents the case of a 55-year-old woman with BRCA-mutated ovarian cancer and provides her initial impressions.
Case: A 55-Year-Old Woman with BRCA-Mutated Ovarian Cancer
Leslie Randall, MD, MAS: Hi, I’m Leslie Randall. I’m a gynecologic oncologist at the Virginia Commonwealth University Massey Cancer Center in Richmond. Let’s get into a case. A 55-year-old patient presents to her primary care doctor with heart burn and abdominal pain that started approximately 2years earlier. Transvaginal ultrasound showed bilateral ovarian masses, and a CT scan revealed masses in the adnexa measuring at least 5.8 cm, with evidence of liver capsule and retroperitoneal node involvement. The patient’s CA-125 measured 3600 U/mL. This was a patient whom we considered a candidate for surgical intervention, and she underwent primary cytoreductive surgery with hysterectomy, removal of the omentum, the appendix, and all the visible disease. The patient had disease up to 2.2 cm, but all of that was removed. Her final stage was IIIC, and the histology was high-grade serous ovarian cancer. IHC [immunohistochemistry] testing was positive for a mutant P53, PAX8, WT1, and CK7. That gives us confidence that this was a [gynecological] origin, but the high-grade serous told us that too. We need more biomarker information.
The patient underwent germline BRCA testing and did have a BRCA1mutation. She received [intravenous] carboplatin paclitaxel for 6 cycles postsurgery, and then she experienced myelosuppression and, most notably, a neutropenia after cycle 3, which required postponement of the next cycle. The follow-up imaging, which is very typical in these patients, did show a complete remission after completion of the chemotherapy. The CA-125 level was back into the normal range of 30.5U/mL. For this patient, maintenance therapy with a PARP inhibitor was initiated. Three weeks into the PARP inhibitor treatment, her hemoglobin was 7 g/dLand she required a blood transfusion.
This is a very typical case of ovarian cancer. This patient [has] stage III [disease], which is the most common stage at which patients are diagnosed. She was a good candidate for primary surgery, which we most of the time can’t do. Most of the patients need neoadjuvant chemotherapy. Because she had a complete gross resection, and because she had no disease at the completion of chemotherapy, her prognosis is good. That is irrespective of the BRCA mutation. Now that we know that she has a BRCA1 mutation, her prognosis is even better because she will most likely respond to PARP inhibitor and have a significant benefit from that.
Transcript edited for clarity.