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How to treat a 63-year-old woman with recurrent, symptomatic low-grade serous ovarian carcinoma (LGSOC)? That was the dilemma faced by a team at City of Hope Cancer Center in Duarte, California.
As Edward Wenge Wang, MD, PhD, and other colleagues at City of Hope and Beckman Research Institute related in case report in JCO Precision Oncology, the patient had been diagnosed 13 years earlier, in 2013, with FIGO stage IIC serous borderline ovarian tumor after undergoing total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymph node dissection, and comprehensive surgical staging. Her preoperative CA-125 level was 5,252 U/mL.
In 2017, she began to have lower abdominal discomfort, bowel-related pain, and increased urinary frequency; ileocecal and low anterior resection was performed. Pathology showed an invasive low-grade serous carcinoma involving mesenteric and periappendiceal fat, suggesting that the cancer had advanced to be invasive LGSOC. She was treated with tamoxifen, followed by anastrozole (Arimidex) after she developed intolerance, but disease progression continued.
Between 2018 and 2020, the patient received several systemic therapies, including rucaparib (Rubraca), letrozole (Femara), and nivolumab (Opdivo). This was followed by low-dose insulin potentiation therapy incorporating platinum, alkylator, anthracycline, antimetabolite, and taxane agents, but response was only short-lived. Anastrozole was resumed in 2020 but discontinued the next year after imaging showed progression.
