59yr female with high grade serous ovarian carcinoma treated with carbo/taxol/bev x 6 then debulking which showed FIGO IIIa residual disease. She did not tolerate maintenance zejula and recurred right at 6 months. I’ve called her platinum sensitive and started carbo/gem/bev. Ca125 went from 157 to 116 after C1 but she developed carbo reaction after C2. My institution does not have desensitization protocol. Tissue NGS: TP53 and NF2+, Her2-. Germline BRCA negative. What would you recommend next? Good PS.
Its unfortunate that patient developed HSR to carbo. You have the option of continuing Gem/ Bev alone, or change to weekly Taxol/ BEV. If FOLR1 not tested, recommend sending tissue for testing , if high expression, may benefit from Mirvetuximab if progress on second line. Clinical trial is another option.
