Complete pathological response to olaparib and bevacizumab in advanced cervical cancer following chemoradiation in a BRCA1 mutation carrier: a case report

Abstract

Background Homologous recombination deficiency is a marker of response to poly(ADP-ribose) polymerase inhibitors in different cancer types including ovary, prostate, and pancreatic cancer. To date, no report about poly(ADP-ribose) polymerase inhibitors has been published on cervical cancer. Case presentation Here we present the case of a patient with cervical cancer treated in this setting. A 49-year-old woman diagnosed with International Federation of Obstetricians and Gynecologists stage 2018 IIIC2 locally advanced undifferentiated cervical cancer received first-line chemoradiotherapy followed by carboplatin, paclitaxel, and bevacizumab with partial response. Because of a family history of cancers, the patient was tested and found positive for a pathogenic BRCA1 germline and somatic mutation, which motivated bevacizumab plus olaparib maintenance treatment. A simple hysterectomy was performed after 2 years stable disease; pathological report showed complete pathological response, and 12 months follow-up showed no recurrence. Conclusion Poly(ADP-ribose) polymerase inhibitors could be an alternative maintenance treatment for patients with persistent advanced cervical cancer previously treated with platinum, especially when familial history of cancers is reported. Clinical trials using poly(ADP-ribose) polymerase inhibitors for advanced cervical cancer are warranted.

Case report: Response with chemotherapy and Olaparib in a patient with advanced cervical adenocarcinoma

“…Pelvic MRI showed a decrease of 50% in the tumor. After a one-year follow-up, clinical and radiological examination, no recurrence was found [17]. Another case report showed that a uterine serous carcinoma patient with BRCA2 mutation was treated with Olaparib.…”

Dramatic Radiographic Response of Pelvis-Filling Locally Advanced Cervical Cancer Treated With Radiation and Chemotherapy

“…Another case report was conducted by Montero-Macias et al, which focused on a 49-year-old female with FIGO stage IIIC2 locally advanced undifferentiated cervical cancer [ 13 ]. This patient had a 9.1 cm mass that involved her cervix, uterus, uterine serosa, parametrium, and left pelvic wall, and she developed a left hydronephrosis.…”

“…The patient had a partial response to treatment at the three-month follow-up. With only a partial response, the decision was made to offer additional therapy consisting of carboplatin, paclitaxel, plus bevacizumab [ 13 ]. Following the completion of this regimen, the tumor size decreased by half, and a simple hysterectomy was performed.…”

Recurrent Cervical Cancer Treated Successfully with Single-Agent PARP-Inhibitor, Olaparib

“…Results from NSC #737664, which evaluated use of veliparib in combination with topotecan and GCSF demonstrated poor response with a partial response rate of 7%, median PFS of 2 months as well as significant toxicity [ 16 ]. One case report was recently published documenting complete response to combination therapy with olaparib and bevacizumab in a patient with advanced cervical cancer [ 17 ]. Additional trials are ongoing with PARP-inhibitors rucaparib and niraparib in combination with bevacizumab and concurrent radiation therapy, respectively [ 18 , 19 ].…”