Optimal treatment strategy for a patient with advanced ovarian cancer without deterioration in the quality of life: a clinical case
National Medical Research Center for Obstetrics, Gynecology and Perinatology n.a. Acad. V.I. Kulakov, Moscow, Russia
Background. Platinum-containing combinations of drugs remain the drug of choice both for the 1st-line therapy and the therapy of platinum-sensitive relapses for patients with ovarian cancer. In some cases, it is necessary to select alternative approaches to reduce the effects of toxicity, allergic reactions, as well as in the case of relapses that develop in the interval without treatment for less than 1 year.
Description of the clinical case. A patient with a diagnosis of T3CN0M0, grade III, was admitted with complaints of ascites, an increase in the volume of the abdomen, weakness, shortness of breath during physical exertion. An additional examination revealed cystic and solid components in both ovaries, metastases along the peritoneum, forming confluent dissemination along the peritoneum of the pelvis, with extension to the greater omentum. Due to the stage of the disease and the moderately grave condition of the patient, it was decided to start with neoadjuvant chemotherapy (CT) according to the scheme: paclitaxel + carboplatin with a partial effect according to ultrasound examination and a decrease in the CA marker level. Extirpation of the uterus with appendages, removal of a large omentum in a non-optimal volume was performed. Due to the treatment, it was possible to increase the time to the third chemotherapy by 20 months, which allowed the patient to recover after the previous taxane-platinum therapy. A further strategy for choosing CT taking into account factors such as residual polyneuropathy stage 1, the presence of a BRCA1 mutation, the patient’s desire to use drugs that do not cause alopecia, is described. Subsequently, the patient received olaparib in a maintenance regimen for 16 months; good tolerability of treatment was noted.
Conclusion. The case described indicates the importance of competent sequential alternation of treatment of patients with ovarian cancer, which allows achieving significant stabilization of the patients’ condition, regression of the oncological process, without deterioration in the quality of their life.
About the Autors
Corresponding author: Svetlana V. Khokhlova, National Medical Research Center for Obstetrics, Gynecology and Perinatology n.a. Acad. V.I. Kulakov, Moscow, Russia; e-mal: firstname.lastname@example.org
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