Case Reports - Extensive Cutaneous Metastases of Ovarian Cancer After Prolonged Response to Liposomal Doxorubicin

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Highlights

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Cutaneous (skin) metastases are rare and clinically challenging to manage. When present, they often represent end-stage disease.

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Treatments for cutaneous metastases are limited, and primarily palliative in nature.

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INTRODUCTION

In 2012, an estimated 22,280 women will be diagnosed with ovarian cancer and 15,500 will die of the disease.¹ Approximately seventy-five percent of women diagnosed with ovarian cancer in the United States have stage III or more advanced disease at diagnosis. Although most patients respond to initial treatment, the rate of recurrence after initial treatment of ovarian cancer is as high as 65% to 75%. The most common site of recurrence is within the peritoneal cavity. In a postmortem study, Rose et al. evaluated the patterns of ovarian cancer metastasis and found that the most common sites of metastasis were the peritoneal cavity, paraaortic lymph nodes, large intestine, pelvic lymph nodes, and liver.²

Ovarian cancer can metastasize by direct extension and transport throughout the peritoneal cavity and/or through lymphatic or hematogenous spread. Cutaneous metastases are rare, occurring in 1.9% to 5.1% of patients.³ Cutaneous metastases are often a late manifestation of the disease and have a propensity to occur within previous surgical scars, although cases of cutaneous metastases to the limbs have also been reported. Cutaneous metastases most commonly manifest as small nodular lesions but can also manifest as herpetiform erythematous lesions and scarring plaques.

Treatment of recurrent metastatic ovarian cancer involves systemic chemotherapy with agents chosen on the basis of previously demonstrated platinum sensitivity or resistance. Pegylated liposomal doxorubicin (PLD) is a cytotoxic agent that has demonstrated efficacy in the treatment of recurrent platinum-sensitive and platinum-resistant ovarian cancer. In patients with platinum-resistant ovarian cancer, PLD as a single agent has shown a survival benefit nearly equal to what is observed with other cytotoxic agents but is associated with less toxicity. Given these findings and its relatively convenient dosing, PLD is often chosen as the preferred agent for patients with recurrent platinum-resistant ovarian cancer.

Case

 

Case

A 64-year-old woman was diagnosed with at least stage IA high-grade serous ovarian carcinoma following a laparoscopic bilateral salpingo-oophorectomy. The patient was subsequently referred to The University of Texas MD Anderson Cancer Center for further treatment. After review of pathology slides, the patient was treated with six cycles of paclitaxel (175 mg/m²) and carboplatin (AUC = 5), which were completed in May 2006. She had no evidence of disease upon completion of therapy.

Approximately 5 months after completion of therapy, computed tomography (CT) revealed disease recurrence in the form of a 1-cm subcutaneous nodule involving the left rectus abdominus muscle and a 1-cm peritoneal deposit within the pelvis. The serum CA-125 level was 7.1 U/mL. Given that disease had recurred after platinum-based therapy, the decision was made to treat the patient with single-agent PLD (40 mg/m²) every 28 days............