Elsevier

Gynecologic Oncology

Volume 116, Issue 3, March 2010, Pages 578-579
Gynecologic Oncology

Case Report
A case of progressive mucinous ovarian cancer of low malignant potential responsive to biologic therapy with Bevacizumab

https://doi.org/10.1016/j.ygyno.2009.10.068Get rights and content

Introduction

Approximately one ovarian tumor in nine is a tumor of low malignant potential (LMP). The initial therapy is primarily surgical. Cure rates are reported between 70% and 99% [1]. Stage, debulking status, and micropapillary features are the primary prognostic indicators. While not classified as malignant tumors, these tumors can progress and are a challenge to treat. Surgery remains the primary treatment modality [2]. When surgery is not an option, chemotherapy has been used with reports of stable disease in ∼ 50% of patients. However, LMPs are traditionally thought to be non-chemoresponsive and there are no prospective trials demonstrating a survival advantage for the use of chemotherapy in progressing ovarian LMP [1]. Ultimately with progressive disease, patients succumb secondary to treatment failure.

Given the lack of a clear benefit for chemotherapy in LMP tumors, Biologic therapy, has significant appeal as a treatment modality. Bevacizumab (Bevacizumab®, Genetech) is a biologic therapy that binds to the vascular endothelial growth factor (VEGF) and inhibits angiogenesis. Given (1) Bevacizumab targets tumor vasculature and not the tumor cells and (2) Bevacizumab has demonstrated significant activity in invasive ovarian cancer [3], we speculated that Bevacizumab may be active in ovarian mucinous LMP tumors. We describe here a case of a patient with an ovarian mucinous LMP tumor who was non-responsive to chemotherapy yet demonstrated prolonged response to Bevacizumab with both initial exposure and upon re-treatment.

Section snippets

Case

A 35-year-old female presented with bloating and constipation and was found to have a pelvic mass and ascites. CA125 was 110. She underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, lymph node dissection and biopsies. Pathology revealed a stage IIIa mucinous ovarian carcinoma of low malignant potential with diffuse involvement of bilateral ovaries, peritoneum, and omentum. No adjuvant therapy was recommended.

After 9 months the patient had recurrent bloating

Discussion

Ovarian LMP tumors are treated primarily with surgery. When progressive LMP tumors are inoperable there are no proven treatment modalities; Chemotherapy trials in LMP tumors have not demonstrated a survival advantage. There is a rationale for antiangiogenic therapy in slow growing tumors such as ovarian LMP tumors. While chemotherapeutics typically target the cellular division machinery of rapidly proliferating cells, antiangiogenic therapy targets tumor neovasculature to restrict tumor growth.

Conflict of interest statement

The authors have no conflicts of interest to report.

References (4)

  • C.L. Trimble et al.

    Ovarian tumors of low malignant potential

    Oncology (Williston Park)

    (2003)
  • R.Y. Zang et al.

    Recurrent ovarian carcinoma of low malignant potential: the role of secondary surgical cytoreduction and the prognosis in Chinese patients

    J. Surg. Oncol.

    (2005)
There are more references available in the full text version of this article.

Cited by (0)

View full text