Prolonged Complete Response to Retreatment with Olaparib in a Patient with Resected Single Brain Metastasis of Recurrent BRCA2-Mutated Ovarian Cancer.

The incidence of brain metastases in ovarian cancer is quite rare, being approximately 1.34%. According to retrospective studies, patients with BRCA 1/2 mutations present a higher risk. The trimodal approach based on surgery, radiotherapy and chemotherapy presents greater benefits in terms of overall survival. In preclinical studies, inhibitors of Poly ADP ribose polymerase have been shown to cross the blood-brain barrier, being an alternative to control the disease at the systemic level and at the level of the central nervous system. The SOLO2 (olaparib), NOVA (niraparib) and ARIEL3 (rucaparib) clinical trials do not refer data on patients with brain metastases, the published evidence for iPARP in this population comes only from case reports.

We present the case of a 54-year-old woman with stage IV high-grade serous papillary carcinoma who, after 37 months of maintenance olaparib, presented a single brain lesion. After radical treatment restarted olaparib, remaining disease-free 13 months since Olaparib restart and 87 months since the diagnosis. This case suggests that, if we achieve a radical treatment of brain metastasis and the disease at a systemic level is controlled, a reasonable option is to maintain systemic maintenance treatment with iPARP.