How Surgery, Combination Chemotherapy, and Targeted Therapy Provided Relief

An 82-year-old woman first presented in May 2004 with abdominal distension, pain, early satiety, and increased urinary frequency—symptoms consistent with advanced ovarian cancer. She underwent a hysterectomy, bilateral salpingo-oophorectomy, and an omentectomy, revealing widespread stage IIIC epithelial ovarian cancer with omental and diaphragmatic metastases. Following surgery, she received six cycles of paclitaxel and cisplatin, successfully reducing her CA-125 level to 7.3 U/ml while alleviating her abdominal pain and distension.

However, by May 2007, new onset of abdominal distension and deteriorating health indicated recurrence. Imaging showed suspicious lesions in the liver, spleen, and lymph nodes, plus left pleural effusion. With an ECOG performance status of 4, she could not tolerate further standard chemotherapy. Instead, she received low-dose oral etoposide and megestrol acetate, along with goserelin acetate injections. Despite these efforts, she developed severe ascites and breathing difficulties, necessitating repeated thoracentesis and abdominocentesis. Intraperitoneal (IP) carboplatin was also administered, but her condition continued to worsen.

On May 27, 2007, she received a 200 mg intravenous infusion of the anti-VEGF agent bevacizumab, followed by repeated thoracentesis for symptomatic relief. Remarkably, from June onward, she experienced improved breathing, reduced ascites, and better appetite. She continued on bevacizumab every two weeks at a modified dose, with imaging showing disappearance of pleural effusion, ascites, and some lesions. Her CA-125 declined to 31.17 U/ml, and additional IP carboplatin treatments were given intermittently.

Despite these measures, a PET-CT in November 2007 uncovered widespread metastatic disease once again. While the patient sustained a period of disease-free survival through mid-2009, her cancer ultimately progressed in August 2009. She passed away in September 2009 from multiple organ failure, underscoring the aggressive nature of advanced epithelial ovarian cancer. Yet, her transient improvements demonstrate the potential benefits of combining targeted therapies like bevacizumab with repeated IP chemotherapy in patients who can tolerate it.