【OC Archives】Combined with a variety of underlying diseases, Nirapali decisively started to provide sustained benefits for patients with advanced ovarian cancer and liver dysfunction

The preferred treatment mode for ovarian cancer is cytoreductive surgery combined with platinum-based chemotherapy

Professor Wei Jihong

Master of Medicine, Sun Yat-sen University

Chief Physician of Gynecology, Jiangmen Central Hospital

Member of the Hysteroscopy Group of the Gynecological Endoscopy Branch of the Guangdong Medical Association

Member of the Female Reproductive Surgery Branch of Guangdong Plastic Surgery Association

Medical status, profession and achievements: 21 years of experience in gynecology, good at standardized diagnosis and treatment of gynecological benign and malignant tumors; good at laparoscopic minimally invasive surgery for gynecological benign and malignant tumors, hysteroscopic minimally invasive surgery for various uterine cavity diseases, and cervical diseases He has rich experience in the diagnosis and treatment of endocrine diseases such as genital malformations, menstrual abnormalities, and infertility

Case sharing

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Case review

basic information

The patient was a female with a 50-year-old age of onset.

After treatment

The first stage: neoadjuvant chemotherapy + surgery + postoperative chemotherapy

The patient came to the hospital on June 18, 2020 due to "lower abdominal distension for 1 month"

Gynecological examination revealed: normal vulvovaginal development, mild cervix inflammation, normal uterus size, uterine body palpation is not clear, posterior wall and rectal fossa and nodular induration, left adnexal area palpable and a hard mass about 12× 10×10cm, the border is not clear, the movement is not good, and there is no tenderness; the right appendage is not palpable

Initial diagnosis: ovarian serous papillary carcinoma

NACT uses the TC regimen, and mild liver damage begins to occur after a course of chemotherapy

Evaluation after two passes of NACT, gynecological examination: normal vulvovaginal development, mild cervix inflammation, normal uterine size, posterior wall and rectal fossa and nodular induration, left appendix area and a hard mass, about 5×6× 7cm, the border is not clear, the movement is not good, and there is no tenderness; the right appendage is not palpable

Figure 1.

The postoperative diagnosis was high-grade serous carcinoma of the ovary stage IIIB; viral hepatitis B (active stage)

Figure 2.

Genetic testing of the patient after chemotherapy indicated that BRCA1 +, HRD +

Figure 3.

Figure 4.
Changes in blood routine during maintenance treatment with niraparib

Figure 5.
Enhanced CT of the pelvis and abdomen after Nirapali maintenance treatment (2021-06-01)

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Case summary

This patient is ovarian serous papillary carcinoma stage IIIB.
When choosing the initial treatment plan, consider the patient's severe tumor burden, low physical status ECOG score, poor surgical tolerance, and difficulty in achieving the ideal reduction.
In order to reduce tumor burden and Difficulty of the operation, NACT treatment is given first
.
The patient has hepatitis B virus, poor resistance, HNV active stage, and severe liver damage after two courses of NACT, so he was treated with entecavir, bicyclol, compound glycyrrhizin, sodium glucuronate and other antiviral and liver protection treatments
.
IDS was performed later, and 4 courses of TC chemotherapy plus liver-protecting antiviral treatment were continued after the operation.
The process went smoothly and the liver function did not appear to be abnormal again
.
After completing the initial treatment, in terms of maintenance treatment, considering that the patient's genetic test is positive for BRCA1, the liver cell function of viral hepatitis B (active phase) is poor, and the condition of the disease is comprehensively evaluated, and the maintenance treatment is selected niraparib
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It has lasted for more than 9 months.
The tumor markers were rechecked, blood routine and liver function were basically normal, and the patient's quality of life was good
.
No recurrence was seen, and the treatment effect was good
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