Treatment After Third-Line Therapy in Ovarian Cancer

Amina Ahmed, MD:The patient had carboplatin-Gemzar [gemcitabine] with her last treatment and had a complete response. She now presents with disease again in the lung and an elevated CA-125. If she stayed platinum sensitive, she could be rechallenged with CARBO [carboplatin], likely Doxil [doxorubicin], because she hasn’t seen that in her treatment. And then I would definitely add a PARP inhibitor in maintenance as long as she’s shown a response to the platinum. Otherwise, she has other options depending on her platinum sensitivity. If she was platinum resistant, she could see Doxil [doxorubicin] alone with Avastin-topotecan plus or minus Avastin. She could see Alimta [pemetrexed]. We don’t know her genetic status actually, so I would definitely make sure that we assessed herBRCAstatus and HRD [homologous recombination deficiency] status.

The patient in this case, because we don’t know her genomic or somatic testing, should have both blood testing forBRCAas well as HRD testing.

One thing about HRD testing is that all patients should have, as I said,BRCAtesting—genomic testing, full panel, as well as somatic testing specifically looking at HRD.

I don’t think that CA-125 predicts response to treatment. I think CA-125 is a good marker for response, and it’s important to know somebody’s CA-125 is a predictive marker for them, but I don’t know that an elevated CA-125 versus a lower CA-125 is predictive of response.

This patient particularly does have a low BMI [body mass index], and low BMIs can potentially predict toxicity to treatment. In particular, patients may have lower reserve, lower albumin, and that may actually show that there’s higher toxicity. Patients may have higher toxicity with cytotoxic chemotherapy. We do know that patients who have a lower BMI may also have higher toxicity with immunotherapy, specifically PARP inhibitors.

Transcript edited for clarity.

Case: A 56-Year-Old Female With Recurrent Ovarian Cancer

• 56-year-old female diagnosed with stage IV ovarian cancer (2016)
  • Weight: 105-lb, height: 5’6”, BMI of 16.9
  • Pathology: high-grade serous carcinoma, epithelial ovarian cancer
  • CA-125: 475 U/mL
  • CT with contrast of the pelvis, abdomen, and chest revealed a 3.5-cm mass in the right ovary and peritoneal carcinomatosis
  • Patient underwent suboptimal debulking surgery; residual disease 1.5 cm
  • Received IV/IP carboplatin/paclitaxel (6 cycles); achieved complete response
• 1 year later (2017) symptoms returned; CA-125, 265 U/mL; ECOG: 1
  • Received carboplatin/paclitaxel (6 cycles) and bevacizumab; achieved good partial response; CA-125, 45 U/mL; continued on bevacizumab maintenance
• 8 months following second-line therapy (2018), again presented with symptoms; CA-125, 550 U/mL; ECOG: 0
  • Received carboplatin/gemcitabine (6 cycles); CA-125, 54 U/mL; achieved complete response
• Currently:
  • CA-125, 585 U/mL
  • CT shows 2.7 cm right lower lobe lung mass
  • ECOG: 0