What happened, in summary

A 69-year-old woman was referred in February 2021 with bilateral ovarian tumors, extensive peritoneal disease, massive ascites, enlarged lymph nodes, and a CA-125 level of 4,685 U/mL. She had previously been treated for breast cancer at ages 44 and 56 and had a family history of breast and ovarian cancer. Germline testing identified a pathogenic BRCA1 variant, c.188T>A (p.Leu63*). Her ovarian cancer was classified as stage IIIC because of peritoneal dissemination without distant metastases.

She received 4 courses of neoadjuvant paclitaxel and carboplatin. The tumors shrank and the ascites disappeared. Interval cytoreductive surgery included hysterectomy, removal of both ovaries and fallopian tubes, omentectomy, right and left hemicolectomy, sigmoid colectomy, resection of disseminated lesions, and creation of a colostomy. Complete macroscopic surgery was achieved, and pathology showed high-grade serous carcinoma. Three more courses of paclitaxel and carboplatin produced a partial response, after which olaparib maintenance was started.

Five months later, imaging identified a locoregional recurrence. Laparoscopy showed no new peritoneal or mesenteric dissemination, and secondary cytoreductive surgery completely removed a metastatic hepatoduodenal mesenteric lymph node. After 2 courses of weekly nedaplatin, a new pelvic lesion appeared. Niraparib 200 mg daily was started. Two months later, the lesion had shrunk and CA-125 had normalized. Grade 2 thrombocytopenia improved after a 2-week break, allowing treatment to resume. At 15 months, she had achieved a complete response and remained progression-free on niraparib.