Successful Neoadjuvant and Adjuvant Treatment of High- Grade Serous Carcinoma of the Ovary with BRCA1 Somatic Mutation: A Case Report

Successful Neoadjuvant and Adjuvant Treatment of High- Grade Serous Carcinoma of the Ovary with BRCA1 Somatic Mutation: A Case Report

Founder and Chairman, HealthCare Global (HCG) Enterprises Ltd, Bengaluru, India Chief Scientific Officer, Corporate Research, HealthCare Global (HCG) Enterprises Ltd, Bengaluru, India Master in Oncologic Imaging, University of PISA, Italy. Head & Director of Radiology, Program Director, Fellowship in Oncoimaging. HCG Cancer Centre, Bengaluru, India Pathologist, Department of Molecular and Clinical Genomics, Triesta Sciences. (A Unit of HealthCare Global Enterprises Ltd), Bengaluru India Clinical Pharmacologist and Senior Manager, Department of Clinical Pharmacology, HCG Enterprises Ltd., Bengaluru, India Medical writer, HealthCare Global (HCG) Enterprises Ltd, Bengaluru, India

^*Correspondance to: Lakshmipriya Kumar 

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Abstract:

High-grade serous carcinoma (HGSC) is the most common ovarian cancer, linked to BRCA1 mutations. Though initial response to treatment is good, relapse is common within a few years. We present the case of a 55-year-old woman diagnosed with advanced-stage HGSC who had a somatic BRCA1 mutation. She was on neoadjuvant chemotherapy with Polymeric Micelle Formulation of Paclitaxel, carboplatin, bevacizumab, and atezolizumab. Unfortunately, atezolizumab had to be discontinued after three doses due to immune-related side effects. Subsequently, the patient underwent cytoreductive surgery. A comprehensive pathological evaluation confirmed the presence of residual disease with no evidence of metastasis. After six chemotherapy cycles, her CA-125 levels dropped significantly, from 2350 IU/ml to less than 5.5 IU/ml and reached normal levels on further treatment, showing tremendous response. Maintenance therapy was done with olaparib. In view of the possibility of recurrences and other side effects, her case was further reviewed. As she had cytoreductive surgery with margin positivity near the ureter, she was advised to continue Olaparib beyond 3 years with close monitoring. Over the due course of months, the patient showed no signs of disease. With a thorough MDT discussion, olaparib therapy was extended beyond the standard two-year duration. Regular follow-ups revealed a further drop in CA-125 levels. This case highlights the treatment approach combining chemotherapy, surgery, and adept surveillance. It also supports the use of olaparib in high-risk patients and emphasizes the need for long-term monitoring.

Keywords:

Olaparib, Carcinoma, Serous, Somatic mutation, BRCA1 Gene, CA-125 antigen

Cite the Article:

Ajaikumar BS, Kumar L, Shivakumar Swamy S, Balaram G, Tripathi P, Reethika. Successful Neoadjuvant and Adjuvant Treatment of High-Grade Serous Carcinoma of the Ovary with BRCA1 Somatic Mutation: A Case Report. Ann Clin Case Rep. 2025; 10: 2806..