Management of platinum-resistant/refractory ovarian cancer
Eric Pujade-Lauraine, MD, PhD

A 62-year-old retired nurse with type II diabetes on oral anti-diabetic therapy was diagnosed with serous high grade stage IIIC ovarian cancer. TAH, BSO, omentectomy, and tumor debulking were performed with residuals more than 1 cm. She received standard chemotherapy with 6 courses of paclitaxel and carboplatin and a complete clinical remission was achieved.
 
Follow-up: 13 months later she developed abdominal pain, bloating and swelling. She had clinical ascites, her CA125 was 120 U/mL, and CT scan showed evidence of peritoneal recurrence with ascites.She again received paclitaxel and carboplatin. After 3 cycles of therapy, ascites had disappeared, symptoms were improved and CT scan evidenced an objective partial response. However, she developed grade 2 sensory neuropathy. She received 3 additional cycles of chemotherapy with carboplatin alone. Tumor assessment after 6 cycles did not show any additional response. CA-125 at that time was 42 U/mL.  
 
Three months later she again developed ascites with recurrent abdominal symptoms . ECOG performance status was 2 and improved after paracenthesis. Residual grade 1 peripheral neuropathy. CA125 was increased up to 250 U/mL. Other lab tests were normal. Radiology: progression of the tumoral lesions