case presentation 2 - anzgog€¦ · case presentation 2 michelle harrison chris o’brien...
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![Page 1: Case Presentation 2 - ANZGOG€¦ · Case Presentation 2 Michelle Harrison Chris O’Brien Lifehouse and Liverpool Hospital Rare cancers. SH, age 31 - Right cystectomy x 2 (age 15](https://reader035.vdocument.in/reader035/viewer/2022070711/5ec8b4e801148314424233ec/html5/thumbnails/1.jpg)
Case Presentation 2
Michelle Harrison
Chris O’Brien Lifehouse and Liverpool Hospital
Rare cancers
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SH, age 31
- Right cystectomy x 2 (age 15 and 17)
Pathology: Benign
- Right SO and appendectomy (age 19)
Pathology: Mucinous borderline ovarian cancer with focal areas of intraepithelial carcinoma
-Left cystectomy (age 21)
Pathology: Mucinous borderline ovarian cancer
Case study
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Sept 2017:
- US with left cyst and hydrosalpinx
January 2018:
- Increasing lower abdominal discomfort
- CT with left ovarian cyst
- Ca125 17, Ca 19.9 1743, CEA normal
Case study
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Laparotomy and Left SO, omentectomy, pelvic and peritoneal biopsies and endometrial curettings.
- Deposits in the upper abdomen, pelvic brim, right abdominal wall and small bowel serosa
Case study
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Case study
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Referred for opinion: Peritonectomy and HIPEC
Case study
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1. Peritonectomy and HIPEC then chemotherapy
2. Chemotherapy then peritonectomy and HIPEC
3. Chemotherapy and no HIPEC
Management options
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Case study
Diffuse uptake- Soft tissues of the pelvis
adjacent to the bowel- Peritoneum- Surface of the liver- Pelvic bone
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Case study
MRI scan- At least 3 ill-defined osseous
lesions- Highly suggestive of
metastasis
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1. Carboplatin and Paclitaxel
2. Carboplatin, Paclitaxel and Bevacizumab
3. Oxaliplatin and 5FU / Capecitabine
4. Oxaliplatin and 5FU / Capecitabine and Bevacizumab
5. Chemotherapy then peritonectomy and HIPEC (if responds)
Management options
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Oxaliplatin and Capecitabine
Progress imaging after 3 cycles:
- No evidence of residual peritoneal or serosal
liver disease
-Increasing size and
number of bone metastasis
in the pelvis
Case study
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1. Continue Oxaliplatin and Capecitabine
2. Switch to Carboplatin and Paclitaxel
3. Pelvic radiotherapy
4. Biopsy bone lesion and Peritonectomy and HIPEC if negative
5. Look for clinical trial options
Management options
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Biopsy performed
Case study
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Continued Oxaliplatin and Capecitabine
Referred to MoST
Progress imaging after 6 cycles:
-Stable appearances
-No new sites of disease
Clinically well with no disease symptoms
Neuropathy with Oxaliplatin
Case study
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MoST report
Case study
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KRAS p.G13D
KRAS mutations are common in mucinous ovarian cancerKRAS p.G13D is oncogenic, not the most common 'hot-spot' mutation
46 mucinous ovarian cancer cases, genie.cbioportal.org/
Gene MutationsPathogenic/Likely Pathogenic
Not Detected
Not Tested
HRD Status CCNE1 CN Status
Deficient Amplified (>8 copies)
Intact Gain (4-8 copies)
Unknown NormalNot tested
Mucinous
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RAF-dimer inhibitor (BGB-283) in KRAS mutated cancers
Desai et al AACR 2017
Option - New Trial: Phase I combination RAF-dimer inhibitor and MEK-inhibitor
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Hope or Hype?
Where to next?
Case study
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1. Carboplatin and Paclitaxel
2. Carboplatin
3. Capecitabine
4. Other “GI style” chemotherapy regimen
5. No further treatment
Management options