1. GEMSTONE Educational Case Summary
How do you manage a patient with BRCAmut platinum-sensitive recurrent ovarian cancer?
GEMSTONE Educational Case Summary
Last Update: March 23, 2018
GEMSTONE, a committee of ovarian cancer experts, provided direction and approval of the hypothetical patient scenario presented in this educational resource. TESARO, Inc. provided writing and organizational support to GEMSTONE in the generation of this material.

2. Case Objectives
Review factors affecting choices of initial management options for a patient with recurrent ovarian cancer
Outline types of mutations that can affect treatment decisions in ovarian cancer care
Discuss how presence of germline BRCA mutation affects treatment decisions
Assess how adverse events experienced with front-line treatment shape subsequent management decisions in recurrent setting
BRCA, breast cancer susceptibility gene.

3. Patient History and Baseline Characteristics
Age
42 years
Gravidity and parity
G2P2
Occupation
Software developer
Medical history
Premenopausal
Family history
Ovarian and breast cancers
Baseline Characteristics
Performance status
Symptoms
Subacute right mid- to upper abdominal pain and generalized distention
Comorbidities
None
G, gravida (pregnancy); P, para (birth).

4. Laboratory Tests, Imaging, and Biomarkers
Laboratory Testing
Liver function
Normal
Renal function
CBC findings
Chemistry findings
Other
None performed
Imaging
CT scan: C/A/P
Biomarkers Testing
BRCA1
Germline mutation
BRCA2
Wild-type
CA-125 (<35 U/mL)
838 U/mL
Other tests
None performed
BRCA, breast cancer susceptibility gene; CA, cancer antigen; C/A/P, chest, abdomen, pelvis; CBC, complete blood count; CT, computed tomography.

5. Surgical Interventions, Findings, and Diagnosis
TAH/BSO
Omentectomy
Tumor debulking
Findings
Ascites
Extensive intra-abdominal tumor: omentum, bilateral adnexa, uterine serosa, pelvic peritoneum, sigmoid colon serosa/mesentery, R hemi-diaphragm, caudate lobe of liver, splenic hilum
Frozen section histology: Poorly differentiated carcinoma, NOS
Disease involving R hemi-diaphragm unresectable due to proximity of hepatic vein
Diagnosis & Staging
High-grade serous carcinoma
BSO, bilateral salpingo-oophorectomy; NOS, not otherwise specified; R, right; TAH, total abdominal hysterectomy.

6. Treatment Decisions and Outcomes
Primary Treatment
IV carboplatin and paclitaxel
Treatment Outcomes
No evidence of disease by examination, CA-125 levels, and imaging
Residual grade 1 peripheral neuropathy
Posttreatment
Monitor with physical examination and CA-125 levels every 3 mo
Recurrence
14 mo following completion of primary chemotherapy
Diffuse intraperitoneal disease by CT of abdomen and pelvis
Grade 1 early satiety and constipation
Examination shows mild abdominal distention and nodularity of pelvic surface
×6 cycles
CA, cancer antigen; CT, computed tomography; IV, intravenous.

7. Key Discussion Questions?
Key Discussion Questions
What factors should be considered for decisions about surgical interventions?
What is the optimal second-line therapy for this patient with platinum-sensitive recurrent disease?
Does her germline BRCA mutation affect your treatment recommendations?
How would previously experienced adverse events affect treatment decisions?
BRCA, breast cancer susceptibility gene.

8. GEMSTONE
GEMSTONE, a committee of ovarian cancer experts, provided direction and approval of the material in this educational resource. TESARO, Inc. provided writing and organizational support to GEMSTONE in the generation of this material.
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