Stable Brain Metastases During Niraparib Maintenance for Ovarian Cancer

What happened, in summary

A 68-year-old woman presented in 2014 with extensive ascites and a CA-125 level of 4019 kU/L. CT showed widespread peritoneal and omental disease with small retroperitoneal lymph nodes, and biopsy identified poorly differentiated serous ovarian cystadenocarcinoma. Genetic testing found a pathogenic germline BRCA1 mutation.

She received 5 cycles of carboplatin and interval debulking surgery in January 2015, with a good response. Paclitaxel was avoided because of an adverse drug reaction. In July 2016, brain metastases appeared without disease elsewhere and were treated with 30 Gy in 10 fractions of whole-brain radiotherapy. Further brain-only progression in May 2017 was treated with 6 cycles of carboplatin and gemcitabine, producing a good partial response.

She began niraparib maintenance at 300 mg daily in November 2017. Severe thrombocytopenia developed after 23 days, requiring a 3-week pause and repeated dose reductions. A schedule alternating 200 mg and 100 mg maintained her platelet count above 100 × 10⁹/L. After 17 months of niraparib, her brain disease remained stable. She had a performance status of 0 and continued a full, normal quality of life.