Durable response by olaparib for a Japanese patient with primary peritoneal cancer with multiple brain metastases: A case report

Abstract

Brain metastases (BM) from epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) are extremely rare, accounting for 1-2.5% of all cases. Although therapeutic options, such as surgery, irradiation and chemotherapy are proven to yield survival benefit, the overall prognosis of these patients remains unsatisfactory. Poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor, olaparib is useful for patients with recurrent EOC or PPC. However, reports suggesting the efficacy of PARP inhibitors for patients with EOC or PPC with BM are limited. We report the case of a 58-year-old Japanese woman with recurrent PPC with multiple BM. After obtaining informed consent from the patient, we performed BRCA testing that detected a deleterious BRCA 1 mutation. At that time, olaparib was not yet approved in Japan, we learned about the compassionate use program of olaparib called Managed Access Program (MAP). Of note, we have established a system to enroll patients in MAP. After olaparib treatment, the patient exhibited a considerable decrease of BMs. Eighteen months since the initiation of olaparib treatment, the patient has reported no evidence of disease progression. Olaparib maintenance treatment could be effective for Japanese patients with PPC and multiple BMs.

Niraparib as maintenance therapy in a patient with ovarian cancer and brain metastases

“…Olaparib and rucaparib are both FDA-approved as monotherapy to prolong PFS in patients with advanced ovarian cancer and BRCA mutation after multiple lines of chemotherapy; the National Institute for Health and Care Excellence has approved olaparib and are developing guidance on rucaparib at present. We are aware of two case reports showing intracranial responses to olaparib in these cancers—one for leptomeningeal metastases in a BRCA2 -mutated patient with HGSOC and another for cerebral parenchymal metastases in a BRCA1 -mutated patient with primary peritoneal cancer 18 19…”

Cutaneous and Cerebral Metastases From Primary Peritoneal Clear Cell Carcinoma

“…Nevertheless, CNS disease can be established in a number of patients without any neurological deficits [8]. Besides, corticosteroids and antiepileptics, surgical resection, radiotherapy and systemic chemotherapy constitute the best therapy to prolong the survival of these patients [8,13]. Particularly for patients with several cerebral metastases, whole-brain irradiation (+/-chemotherapy) prevails as the chosen treatment option, as proposed to our patient after the second CNS relapse [8].…”

Brain Metastases from Ovarian Cancer: Current Evidence in Diagnosis, Treatment, and Prognosis

“…-a 58-year-old woman with BRCA1 mutation and multiple BMs from high-grade serous OC achieved a complete response after a 21-month treatment with Olaparib [119].…”