A 56-Year-Old Female With Recurrent Ovarian Cancer

Amina Ahmed, MD:The case is a patient who is 56 years old who was diagnosed with stage IV ovarian carcinoma and was treated with a platinum, taxane, and surgery. She then had recurrence a year later, was re-treated with platinum and Taxol [paclitaxel] with Avastin [bevacizumab] followed by Avastin [bevacizumab] maintenance. And then for her third line of chemotherapy at recurrence, she was treated with platinum and Gemzar [gemcitabine] followed by no maintenance. She now has a recurrence with disease in her lung and an elevated CA-125.

I agree with the majority of how this patient was treated. I would probably do a few things differently. I likely would have treated her with her first recurrence with a platinum doublet: carboplatin-Taxol [paclitaxel] versus carboplatin-Doxil [doxorubicin], followed by a PARP inhibitor for maintenance. I would likely hold her Avastin [bevacizumab] for when she became platinum resistant. I do think there’s higher efficacy in that population because there are fewer treatment options. But we do know that you can use Avastin [bevacizumab] multiple times in somebody’s treatment.

I do think that the treatment today would be slightly different from what it was several years ago. We would do genetic testing, genomic and somatic, so specificallyBRCAtesting, as well as HRD [homologous recombination deficiency] testing currently with initial treatment because we do think that if somebody is eitherBRCApositive or HRD positive, we can actually offer them PARP inhibitor maintenance after primary chemotherapy. It is now approved, so that is something that I would offer patients routinely at this point.

As for treatment at the recurrent setting, as I said prior, I likely would treat patients with PARP inhibitors as maintenance after platinum response in a recurrent setting. There are more and more studies looking at PARP inhibitor after PARP inhibitor to see if there’s efficacy after patients are treated with PARP inhibitors initially and then if patients would still respond with subsequent PARP inhibitors. I think the biggest change from several years ago is the utility of genetic testing, specifically genomic and somatic testing.

Transcript edited for clarity.

Case: A 56-Year-Old Female With Recurrent Ovarian Cancer

• 56-year-old female diagnosed with stage IV ovarian cancer (2016)
  • Weight: 105-lb, height: 5’6”, BMI of 16.9
  • Pathology: high-grade serous carcinoma, epithelial ovarian cancer
  • CA-125: 475 U/mL
  • CT with contrast of the pelvis, abdomen, and chest revealed a 3.5-cm mass in the right ovary and peritoneal carcinomatosis
  • Patient underwent suboptimal debulking surgery; residual disease 1.5 cm
  • Received IV/IP carboplatin/paclitaxel (6 cycles); achieved complete response
• 1 year later (2017) symptoms returned; CA-125, 265 U/mL; ECOG: 1
  • Received carboplatin/paclitaxel (6 cycles) and bevacizumab; achieved good partial response; CA-125, 45 U/mL; continued on bevacizumab maintenance
• 8 months following second-line therapy (2018), again presented with symptoms; CA-125, 550 U/mL; ECOG: 0
  • Received carboplatin/gemcitabine (6 cycles); CA-125, 54 U/mL; achieved complete response
• Currently:
  • CA-125, 585 U/mL
  • CT shows 2.7 cm right lower lobe lung mass
  • ECOG: 0