2022-RA-1353-ESGO Severe anaemia following frontline maintenance with iPARP in a BRCA1 mutated high-grade serous ovarian cancer: an unexpected foe. (20th October 2022)

• Record Type: Journal Article
• Authors: Sarivalasis, Apostolos; Liapi, Aikaterini; Dolcan, Ana-Maria; Latifyan, Sofiya; Herrera, Fernanda; Hastir, Delfyne; Fasquelle, Francois; Brouland, Jean-Philippe; Mathevet, Patrice; Hübner, Martin
• Is Part Of: International journal of gynecological cancer. Volume 32(2022)Supplement 2
• Page Start: A400
• Page End: A400
• Publication Date: 2022-10-20
• Subjects: Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2022-ESGO.858
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Introduction/Background: Maintenance with PARP inhibitors (iPARP) has become standard of care for patients suffering from high-grade serous ovarian cancer (HGSOC). Patients harbouring germline BRCA1/2 mutations responding to platinum-based chemotherapy benefit the most from iPARP. Treatment with iPARP can rarely be associated with severe long-term toxicities including myelodysplastic syndromes (MDS) and acute myeloid leukaemia (AML). Methodology: A 74-year-old patient with stage FIGO IIIC HGSOC was treated with six cycles of carboplatinum and paclitaxel chemotherapy, interval macroscopically complete surgical cytoreduction, followed by a two-year maintenance treatment by olaparib. One month after completion, she complained of severe fatigue, shortness of breath and palpitations. Results: She was diagnosed with severe microcytic anaemia, mild lymphocytopenia and normal platelet count. The injected thoraco-abdominal and pelvic CT-scan ruled out interstitial lung disease, HGSOC recurrence and other primary malignant localization notably without liver nor lymph node involvement. Further haematological workup detected iron-deficient regenerative anaemia and the blood smear ruled out an MDS/AML. The endoscopic gastrointestinal assessment by gastroscopy and colonoscopy detected an ulcerated right colic tumour with active bleeding. The patient underwent laparoscopic right colectomy. The pathological assessment confirmed a grade 3, pT2 pN0 (0/17) cM0, sporadic mismatch deficient (dMMR), intestinal adenocarcinoma, harbouring a c.1799T>A (p.Val600Glu) exon 15, BRAF mutation. Conclusion: This report underlines the importance of a comprehensive differential diagnosis for blood-associated toxicities in the aftermath of iPARP maintenance treatment, especially among the BRCA1/2 mutant patients. Interestingly the dMMR colic tumour did not harbour BRCA1/2 mutation by Next Generation Sequencing.