Ovarian Cancer Remission With Olaparib After Chemotherapy Intolerance

What happened, in summary

A 55-year-old woman was found to have a pelvic mass during a routine examination. She had lived with severe immune thrombocytopenic purpura for more than 20 years, with persistently low platelet counts. Biopsy and surgery confirmed high-grade serous ovarian carcinoma. The cancer was Stage III, with tumor involving the omentum and pelvic lymph nodes. She underwent complete debulking surgery that included hysterectomy, removal of both ovaries and fallopian tubes, omentectomy, appendectomy, and pelvic lymph-node dissection. After surgery, she started paclitaxel and carboplatin. Her platelet count then fell sharply, accompanied by bleeding and severe blood-count suppression, so cytotoxic chemotherapy was discontinued. Molecular testing identified a germline BRCA1 mutation. She subsequently started olaparib maintenance. Because of her ongoing platelet disorder, the olaparib dose was adjusted over time while hematology treatment continued for the thrombocytopenia. The cancer remained controlled despite the inability to continue standard chemotherapy. At 48 months of follow-up, imaging showed complete radiologic remission and her CA125 level was within the normal range. She remained on reduced-dose olaparib with stable platelet counts. Her course shows a prolonged remission after treatment had to be adapted around a serious pre-existing blood disorder.