Recurrent Stage III Ovarian Cancer Complicated by Severe Kidney Injury

What happened, in summary

A 71-year-old woman had undergone optimal debulking surgery for Stage III high-grade papillary serous ovarian cancer at age 64. She received carboplatin and paclitaxel followed by 4 cycles of intraperitoneal cisplatin.

When the cancer progressed 6 months later, she entered a phase II trial using pegylated liposomal doxorubicin with bevacizumab. Over more than a year, her kidney function gradually worsened and she developed proteinuria and hypertension. A later rise in CA-125 and abdominal pain led to gemcitabine, but worsening kidney function, shortness of breath, and edema required hospitalization. Kidney biopsy showed thrombotic microangiopathy with chronic damage.

Her symptoms improved somewhat after treatment was stopped, but the ovarian cancer progressed in the abdomen. Paclitaxel and then carboplatin were used for further treatment. In May 2011, she developed seizures, encephalopathy, and lower-extremity ischemia and was hospitalized. She died 1 week later. The case highlights severe kidney complications during prolonged treatment for recurrent ovarian cancer.