Complete remission of heavily treated ovarian clear cell carcinoma with ARID1A mutations after pembrolizumab and bevaciz
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CASE REPORT
Open Access
Complete remission of heavily treated ovarian clear cell carcinoma with ARID1A mutations after pembrolizumab and bevacizumab combination therapy: a case report Yu-Chien Lin1, Kuo-Chang Wen1,2 , Pi-Lin Sung1,2, Yu-Ting Chou1, Phui-Ly Liew3,4, Lin-Yu Chen1, Rui-Lan Huang1,2, Hung-Cheng Lai1,2,5 and Lu-Te Chang1*
Abstract Background: Patients with ovarian clear cell carcinoma (OCCC) have a poor prognosis because they show low sensitivity to platinum-based chemotherapy. New treatments for refractory OCCC are urgently needed. Case presentation: We present a patient with refractory OCCC in whom conventional chemotherapy failed. Cachexia was induced by the disseminating recurrent tumors. Tumor tissue staining and genomic analysis revealed PD-L1 negativity, a low tumor burden, stable microsatellite instability, and two mutations in ARID1A. The patient was administered pembrolizumab combined with bevacizumab triweekly. Her serum CA-125 level decreased dramatically after the first cycle. A computerized tomography scan showed marked regression of the recurrent masses after 3 cycles, and the patient reached complete remission after 9 cycles. She showed good recovery from cachexia. We observed no marked side effects except for mild polyarthritis of the small joints. Conclusions: The therapeutic effect of checkpoint inhibitors combined with angiogenesis inhibitors is very promising in our patient with OCCC. Further clinical trials of tumors including ARID1A mutations are warranted. Keywords: Angiogenesis inhibitor, ARID1A, Checkpoint inhibitor, Ovarian clear cell carcinoma
Background Epithelial ovarian cancer (EOC) is one of the most lethal malignancies in the female reproductive system. Various subtypes of EOC exhibit histological and genomic heterogeneity [10]. Among these different subtypes, ovarian clear cell carcinoma (OCCC) remains challenging to treat [5]. Although optimal debulking surgery followed by platinum-based chemotherapy is the standard therapy * Correspondence: [email protected] 1 Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan Full list of author information is available at the end of the article
for EOC, OCCC can easily become resistant to these conventional treatments [3]. Some studies have suggested that the poor prognosis of OCCC is related to distinct molecular characteristics [13]. Molecular variations, such as ARID1A mutations and overexpression of vascular endothelial growth factor (VEGF), annexin A4, and mammalian target of rapamycin (mTOR), have been reported in OCCC [5]. A precision medicine approach that targets these unique features may be a new direction for OCCC treatment. We present a patient with refractory OCCC who was successfully treated with a combination of an immune
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