Successful management of metastatic ovarian carcinosarcoma with olaparib plus bevacizumab: a case report

Abstract

Background: Ovarian carcinosarcoma (OCS) is a rare, highly aggressive, and treatment-resistant tumor. Some important advances in chemotherapy have been reported, including an anti-vascular endothelial growth factor antibody, bevacizumab (Bev)-containing regimen, and a poly-ADP ribose polymerase (PARP) inhibitor, olaparib. Olaparib is specifically a treatment option for OCSs with breast cancer gene (BRCA) mutations, and the clinical study on the combination of olaparib and Bev was reported for homologous recombination deficient epithelial ovarian cancer. However, there are no reports on treating advanced OCS with BRCA mutations by olaparib plus Bev effectively. In this study, to the best of our knowledge, we report the first case of successful management of multiple liver and para-aortic metastases of OCS with a BRCA mutation using olaparib plus Bev. Case: A 75-year-old woman presented to the hospital with complaints of abdominal distension. A staging laparotomy and histological analysis revealed a primary OCS. She received platinum doublet regimens as adjuvant chemotherapy. As myChoice® CDx test of the surgical specimen revealed a BRCA2 mutation, the combination regimen of olaparib (400 mg daily) plus Bev (15 mg/kg every three weeks) was chosen as the maintenance therapy. After four months of this chemotherapy, a computed tomography scan revealed significant shrinkage of both the liver metastases and para-aortic lymph nodes. Progression-free survival has been noted for over 14 months. Conclusions: The combination therapy of olaparib plus Bev could be a potential therapeutic option for advanced OCS.