Case Study: Olaparib Maintenance for High-Grade Serous Ovarian Cancer With Brain Metastases
Posted: Wednesday, January 6, 2021
A case study published in the International Journal of Gynecological Cancer exhibited findings of a patient diagnosed with ovarian high-grade serous cancer who also presented with brain metastases. Amit M. Oza, MD, of the Princess Margaret Hospital Cancer Centre, Toronto, and colleagues investigated the PARP inhibitor olaparib's role on disease maintenance following stereotactic radiosurgery. After multiple radiosurgeries, olaparib was administered for disease maintenance; however, it may have been ineffective in maintaining disease control, as there were repeated occurrences of intracranial disease.
The patient was a 47-year-old woman who initially presented with abdominal pain, distention, and weight loss. Baseline serum tests confirmed a diagnosis of ovarian high-grade serous carcinoma. CT scans were performed, followed by primary debulking surgery, which culminated in an omentectomy due to the extent of the disease. Following surgery, four cycles of neoadjuvant platinum-based chemotherapy were administered. As the patient had a family history of the disease, a hysterectomy was performed, followed by genetic testing. Upon presentation with headaches and unsteady gait 12 months after initial treatments, MRI revealed brain metastases, which were treated with stereotactic radiation. Olaparib was then administered as maintenance therapy.
Primary genetic testing revealed a positive germline BRCA1 mutation, in line with a familial history of the disease. At 1 year after initial treatment, there was no evidence of extracranial disease; however, there was significant progression of cranial metastases resulting in multiple rounds of stereotactic radiation. Despite maintenance on olaparib, brain metastases progressed.
“This case highlights the complex considerations associated with multimodal treatment in an ovarian high-grade serous carcinoma subpopulation with intracranial metastases. Due to the rarity of brain metastases…, the evidence remains sparse, and a number of questions have been raised surrounding the appropriateness of continuing PARP inhibitors in isolated intracranial progression,” stated Dr. Oza and colleagues.
Disclosure: For full disclosures of the study authors, visit ijgc.bmj.com.
