Effective use of everolimus as salvage chemotherapy for ovarian clear cell carcinoma: a case report
The patient was a 53-year-old woman, gravida 3, para 2. She had first menstruated at age 14 years and reached menopause at age 49 years. Her family history and medical history were unremarkable. Due to the diagnosis of ovarian cancer in 2010, she underwent total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymph node dissection. Adenocarcinoma was diagnosed based on examination of cells from ascitic fluid. The pathological diagnosis of the extracted organ was CCC. Clinically, the ovarian cancer was stage IC. Postoperatively, the patient received six cycles of paclitaxel/carboplatin therapy (paclitaxel 175mg/m2 on day 1, carboplatin area under the curve 6 mg/ml per min on day 1, every 21 days) and achieved remission. Within 6 months after the final administration of this chemotherapy, however, the CA125 level increased and ascites developed, while computed tomography (CT) showed dissemination throughout the abdominal cavity. Accordingly, the diagnosis was platinum-resistant recurrent ovarian cancer. Six cycles of CPT-11/pegylated liposomal doxorubicin therapy (CPT-11 80 mg/m2 on days 1 and 15, and pegylated liposomal doxorubicin 30 mg/m2 on day 3, every 28 days) were started in April 2011. Although the antitumor efficacy after three cycles was sufficient to achieve stable disease (SD), progressive disease was apparent at the completion of six cycles. Therefore, the treatment was switched to gemcitabine/docetaxel therapy (gemcitabine 800 mg/m2 on days 1 and 8, docetaxel 60 mg/m2 on day 8, every 21 days) starting in November 2011. The patient completed five cycles but did not respond to this therapy, showing progressive disease. After a full explanation to the patient and her husband that there would be no next chemotherapy according to the guidelines for recurrent ovarian cancer and that CCC is always chemotherapy resistant, the patient elected to receive oral administration of everolimus. Oral everolimus administration (everolimus 10 mg/day on days 1–28, a 28-day period comprised one cycle) was started in March 2012 as medical care without health insurance coverage. presents CT images before treatment, after three cycles, and after six cycles. shows the changes in CA125 levels. The tumor reduction rate was 11.4%, according to measurements based on CT images. The antitumor response according to Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 was SD. Additionally, the Eastern Cooperative Oncology Group (ECOG) Performance Status was 1 throughout this therapy. During the sixth cycle, however, the patient discontinued treatment for financial reasons. Treatment was thus suspended upon completion of the sixth cycle. With regard to adverse events, the patient developed grade 3 anemia and grade 1 hypercholesterolemia as hematotoxicities in the fifth and third cycle, respectively. As for non-hematotoxicities, she had grade 1 fatigue, grade 1 malaise, and grade 1 stomatitis. The adverse events in each cycle are shown in . These adverse events necessitated neither postponement of the start of the next cycle nor suspension of administration. Starting in October 2012, the treatment was again switched to gemcitabine/docetaxel therapy (gemcitabine 800 mg/m2 on days 1 and 8, docetaxel 60 mg/m2 on day 8, every 21 days). In the middle of the second cycle, a rapid increase in ascitic fluid and CA125 elevation were observed. Thereafter, the patient received best supportive care and died in December 2012.