PMC9899799_01
CT scan on 31 May 2019 revealed multiple masses in the gastrosplenic recess, the inferior capsule border of the spleen, and the right peritoneum (A). Pathology results revealed poorly differentiated metastatic adenocarcinoma (B, C).
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APF, and CA153; however, CA125 was elevated to 62.23 U/mL. A CT scan on 31 May 2019 revealed multiple masses in the gastrosplenic recess, the inferior capsule border of the spleen, and the right peritoneum (Figure 1A). Biopsy of the masses in the gastrosplenic recess indicated poorly differentiated metastatic adenocarcinoma as the differential diagnosis (Figures 1B,C).
Treatment course of the patient (A). CT scans in August 2019 (B) and April 2022 (C) indicated that the patient was experiencing SD. CT scan on 16 July 2021 revealed that the patient was experiencing PD (D). CT scan on 1 October 2021 indicated that masses in the peritoneum and gastrosplenic recess were enlarged and had begun to further invade the spleen (E). PD was observed according to CT scan on December 21 (F). CT scan on 22 February 2022 indicated that the masses had slightly regressed and a decrease in ascites was observed (G). Bev: bevacizumab; Peb: pebolizumab; Anlo: anlotinib.
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In consideration of her age and physical condition, we decided to offer the patient systemic therapy rather than debulking surgery (Figure 2A). The patient experienced stable disease (SD) and CA125 returned to a normal level (Figures 2B,C). A CT scan on 16 July 2021 revealed that the masses in the gastrosplenic recess were enlarged compared to their size on the previous scan (Figure 2D). After two cycles of this regimen, a CT scan on 1 October 2021 showed that the masses in the peritoneum and in the gastrosplenic recess had further enlarged and had begun to further invade the spleen (Figure 2E). December 21 (Figure 2F). During this treatment, the patient's CA125 level increased from 180.70 U/mL to 329.90 U/mL. After 3 cycles of this regimen, a CT scan on 22 February 2022 indicated that the masses in the peritoneum and gastrosplenic recess had slightly regressed, and a decrease in ascites was observed (Figure 2G).
NGS indicated a somatic mutation: somatic BRCA1 exon 17-18 inv.
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The results suggested that this patient harbored somatic BRCA1 exon 17-18 inv (Figure 3), and the tumor mutation burden (TMB) status of the samples was assessed as high (TMB-H).
Variation in CA125 and status of the patient from initial treatment to current treatment. CA125 level decreased sharply after treatment with anlotinib in May 2019 and treatment with PARPi combined with pebolizumab in December 2021.
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Additionally, CA125 was reduced to 191.5 U/mL (Figure 4).