Expert Perspectives on Treating Recurrent Ovarian Cancer - Episode 2

Prognosis of Patients With Ovarian Cancer

Shannon Westin, MD, discusses the prognosis of the case patient and the general prognosis and treatment options for ovarian cancer patients overall.

Shannon Westin, MD: This is certainly a standard case that many of us see in our clinics every day. The prognosis for patients with ovarian cancer is driven by the stage of the cancer.

Certainly, a patient with stage IV ovarian cancer may have a poorer prognosis than someone with some of the lower stages. However, with a combination of surgery, chemotherapy, and maintenance, at the very least we can get about 80% of patients to a state where there is no evidence of disease, as we achieved with this patient.

With the addition of potential maintenance that is targeting the tumor, we are hoping that we are going to see an improvement in her survival rate. We certainly know that we can see an improvement in progression-free survival [PFS]. We are hopeful we can determine if the use of maintenance strategies in this patient will yield an overall survival benefit. That is certainly the expectation, but we do not have that data.

There are other things I would note: There are many types of stage IV, and I think—this is more of an anecdotal situation—we can often predict better outcomes for patients who have a diagnosis of stage IV disease predominately based on, say, an inguinal lymph node, more so than for patients who have a stage IV diagnosis with a liver metastases or lung metastases, or other criteria for stage IV . I do feel good, and I feel that we can resect that disease that led to our patient being classified as having stage IV disease. That is a benefit to her.

Transcript edited for clarity.

Case: A 68-Year-Old Woman With Recurrent Ovarian Cancer

Initial Presentation

  • A 68-year-old female presented with abdominal bloating, discomfort and decreased appetite
  • PMH: unremarkable, postmenopausal; no known family history of cancer
  • PE: abdominal distention, right lower quadrant tenderness on palpation

Clinical work-up

  • Pelvic exam with transvaginal ultrasound showed a right ovarian mass
  • Chest/abdomen/pelvis CT with contrast revealed a right adnexal 4-cm mass, inguinal lymph node involvement and ascites, no pleural effusion
  • Lymph node, adnexal mass biopsy, and paracentesis (1500 cc) cytology confirmed high-grade epithelial ovarian cancer
  • Germline molecular testing: HRD+, BRCA1/2-
  • CA-125, 385 U/mL
  • Diagnosis: Stage 4, high-grade epithelial ovarian cancer
  • ECOG PS 0

Treatment

  • Patient underwent TAH/BSO, lymph node dissection, with optimal debulking; R0
  • IP/IV paclitaxel/carboplatin; PR
  • Followed by niraparib maintenance