Diagnosis
Serous papillary cystadenocarcinoma of the ovaries. Detected BRCA-1 gene mutation. Status post radical surgery and six courses of chemotherapy. Total hysterectomy with bilateral salpingo-oophorectomy performed. Local recurrence in the uterine stump. Tumor spread to the wall of the colon. Status post resection of the transverse colon with tumor and vaginal stump, and excision of the tumor in the abdominal wall. Status post six courses of chemotherapy. Tumor progression observed. Recurrence in the postoperative area, peritoneal carcinomatosis involving the small and large intestines and liver capsule. Status post sixth course of chemotherapy.
Patient:
Female, 42 years old, Kazakhstan
Physician:
Dr. Jörg Falbrede Chief Physician, Department of Gynecology and Gynecologic Oncology Agaplesion Bethesda Klinik
Response from Dr. Jörg Falbrede
The patient has received appropriate treatment. The last chemotherapy, conducted from February to June 2022, would have been carried out in the same way under our protocol. The course of the disease observed from 2014 to 2022 — which is a very long period for ovarian carcinoma — indicates homologous recombination deficiency (HRD insufficiency), confirmed by the BRCA-1 mutation. In this case, the effectiveness of platinum-based agents is evident and scientifically proven.
After the treatment completed in June, I see good prospects for maintenance therapy, which can be highly effective for a certain period. HRD deficiency plays a particularly important role here as well. I would recommend initiating treatment immediately.
The medications used for this therapy are PARP inhibitors, including Olaparib, Rucaparib, and Niraparib. In our clinical practice, we prefer Niraparib. The drug is usually prescribed at a dosage of 200–300 mg (2–3 tablets daily) until disease recurrence. Blood counts must be monitored regularly, as the drug may cause side effects, although it is generally well tolerated. Treatment with PARP inhibitors helps to slow disease progression and delay recurrence. I recommend starting treatment with one of the three PARP inhibitors.
At present, there is no need for a repeat comprehensive examination.
Patient Questions
After taking Olaparib in combination with Bevacizumab, my hemoglobin levels decreased, resulting in anemia, although laboratory tests show no iron deficiency. The hematologist recommends discontinuing both medications for two weeks. The oncologist suggests stopping only Bevacizumab, but he has limited experience with the combined use of Olaparib and Bevacizumab and is unsure which of these drugs may be causing this side effect.
- How can I normalize my blood counts?
- Which medication is likely responsible for the anemia?
Response from the Physician
The anemia is caused by Olaparib. It should be discontinued for four weeks, until blood parameters return to normal. After normalization, the medication can be resumed at a reduced dose of 75 or 100 mg, with continued monitoring of blood counts. Bevacizumab therapy may be continued.