Recurrent Ovarian Cancer and Olaparib-Related Skin Toxicity

What happened, in summary

A woman in her early 70s had been treated for stage IIIC ovarian serous adenocarcinoma about 6 years earlier. Her pathway included platinum-doublet chemotherapy and interval debulking surgery with hysterectomy, removal of both ovaries and fallopian tubes, partial omentectomy, and low anterior resection. After surgery, she received 6 cycles of paclitaxel, carboplatin, and bevacizumab.

About 4 years before the skin symptoms, CT showed peritoneal dissemination and liver metastases. Twelve cycles of paclitaxel, carboplatin, and bevacizumab produced a complete response, after which she started olaparib maintenance at 600 mg per day. Eleven months later, painful ulcerated plaques and swelling developed on her left hand. She also had grade 2 anemia and grade 3 neutropenia. CT showed no ovarian cancer recurrence at that time, and specialist review diagnosed grade 2 olaparib-induced dermatosis.

The rash improved within 2 weeks after olaparib was stopped and topical steroid and oral antihistamine treatment began. When olaparib was restarted, painful swelling returned in both hands and interfered with self-care, so she discontinued it permanently. Peritoneal disease returned within 6 months. She received paclitaxel, carboplatin, and bevacizumab again, with an effective response. At the latest follow-up, she was alive without signs of another recurrence.