Do Not Forget Poly (Adenosine Diphosphate-Ribose) Polymerase Inhibitors in Ovarian Carcinosarcoma

Abstract

Ovarian carcinosarcoma (OCS) is a rare entity with a poor prognosis and without evidence-based therapy. Here, we report the case of a 55-year-old woman with a germline BRCA1 mutation and a stage IV OCS who was proposed olaparib maintenance therapy after three platinum-based chemotherapies in relapsed disease. Currently, the patient has an overall survival of 102 months and progression-free survival of 60 months with olaparib, with a good quality of life and not experiencing any adverse events. Despite the lack of evidence for the use of poly (adenosine diphosphate-ribose) polymerase inhibitors in OCS, our case report proves that patients with a potential biomarker of response to these drugs (such as BRCA mutation and platinumsensitive disease) derive great benefits from it.

Genomic and Molecular Characteristics of Ovarian Carcinosarcoma

“…In another case report, olaparib was used in a patient with OCS with a germline BRCA1 mutation who ultimately required third-line chemotherapy. After treatment with olaparib, PFS was at least 64 months without any adverse events due to olaparib 56 . Another case reported the use of niraparib as maintenance therapy in combination with bevacizumab for a patient with OCS after receiving multiple lines of chemotherapy 52 …”

“…After treatment with olaparib, PFS was at least 64 months without any adverse events due to olaparib. 56 Another case reported the use of niraparib as maintenance therapy in combination with bevacizumab for a patient with OCS after receiving multiple lines of chemotherapy. 52 Because of the rarity of OCS, the response to treatment with ICI largely remains unknown.…”

Disparity in the era of personalized medicine for epithelial ovarian cancer

“…108 Evidence of HRD was found in 15/25 patients with OCS 109 with case reports of durable response to PARP inhibition. 110,111 The ROSCAN phase II/III (NCT03651206) study will explore the role of PARP and checkpoint inhibition in the treatment of OCS using niraparib with and without concurrent dostarlimab (anti-PD1) in recurrent OCS. 112 A second study is combining dual checkpoint blockade in the form of ipilimumab and nivolumab alongside the tyrosine kinase receptor inhibitor cabozantinib 113 ; the use of cabozantinib has primary been in carcinosarcomas originating from other gynaecological sites 114 ; however, VEGFR overexpression is reported 44% of OCS, 115 indicating a rationale for this combination in OCS.…”