PMC9892535_01
Patient course of disease progression and various treatment timelines (A) CA-125 (U/mL) and HE-4 (pmol/L) levels in patient through the timeline Apr 2016 to May 2022. (B) eGFR (mL/min) in patient through the timeline May 2017 to May 2021.
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Paclitaxel (210 mg) + carboplatin (450 mg) intravenous chemotherapy was administered for 6 cycles after the second cytoreduction ( Figure 1 ). The patient's CA-125 levels were descended to normal range after the chemotherapy ( Figure 1 ). Post which a progressive increase in creatinine levels was observed indicating renal impairment ( Figure 1 ), hence chemotherapy was discontinued.
CT images. (A) Right pleura and interlobular pleura; (B) Right pleura and liver; (C) Right pleura; (D) Right pleura and right lung; (E) Right pleura and right lung and liver. (A) In December 2018, multiple small nodule foci were observed in the right pleura and interlobar pleura indicating the possibility of multiple metastases but smaller in size than earlier foci. (B) In October 2019, multiple metastases were observed in the right pleura, which were more and larger than previous lesions. The nodular foci were enhanced at the edge of the S6 segment of the liver. (C) In July 2020, multiple metastases in the right pleura were observed with no significant change in size and number compared with the previous lesions. A lymph node in the hilar region was observed swollen indicating lymph node metastasis. (D) In April 2021, multiple metastases that were larger in size and number were observed in the right pleura and right lung. Multiple enlarged lymph nodes were found in mediastinum and right hilar region. (E) In April 2022, the lesions in the right pleura and right lung were slightly smaller than before; the lesion in hepatic S6 segment was not significantly changed than before.
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Since October 2020, patient received chemotherapy-free regimen (niraparib, anlotinib and megestrol).  Figure 2  represents magnetic resonance images (CT) of lungs and liver showing metastasis.