A Case of Significant Response to Olaparib in a Patient with Primary Peritoneal Carcinosarcoma Diagnosed by Laparoscopic Surgery

Abstract

Primary peritoneal carcinosarcomas which arise from extragenital locations are extremely rare. Carinosarcomas contain both carcinomatous and sarcomatous elements and can be mainly detected in the female genital tract. We herein report a case of primary peritoneal carcinosarcoma diagnosed by laparoscopic surgery and treated with olaparib. A 62-year-old woman referred to our hospital due to abdominal distension. From imaging findings, we suspected advanced primary peritoneal carcinoma, and laparoscopic surgery was thereafter performed. The pathological diagnosis was carcinosarcoma, and the patient received chemotherapy with docetaxel and carboplatin. After three cycles of chemotherapy, the interval debulking surgery was attempted but resulted in suboptimal results. Because the bilateral ovaries were observed with a normal size and normal findings, we considered that the most likely diagnosis was primary peritoneal carcinosarcoma. After the additional chemotherapy and a 6-month observation period, the tumor relapsed. The patient received chemotherapy again, and the peritoneal carcinosarcoma was judged to be a platinum-sensitive tumor. Oral administration of olaparib was thus initiated. Although a dose reduction was needed due to anemia, olaparib was effective, and the patient could continue the drug for another 7 months. This is the first report of primary peritoneal carcinosarcoma treated with olaparib and shows that it could be a treatment option for platinum-sensitive tumors.

Primary Peritoneal Carcinosarcoma in a Breast Cancer Patient Harboring a Germline <i>BRCA2</i> Pathogenic Variant: Case Report

“…Olaparib therapy for PPCS has not yet been reported. Nagamata et al [ 30 ] reported a significant response to olaparib in a patient with a PPCS, although neither germline nor somatic genetic testing was performed to assess BRCA status. In the present case, the patient had a BRCA germline pathogenic variant, but the mutational signature was discordant.…”

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

“…There is another published case report of olaparib maintenance therapy in OCS, but in that case, the patient was BRCA non-mutated. The patient was administered olaparib for recurrent platinum-sensitive disease, with a progression after seven months of therapy [ 14 ]. By comparison, our patient had a better outcome, so the presence of biomarkers ( BRCA mutation) could help to identify the population that would most benefit from this strategy.…”