Recurrent ovarian cancer with BRCA reversion: a case study and comprehensive literature review

Sadanand Karandikar; Himanshi Joon; Shailesh Puntambekar; Amit Nehra; Vivek Chaudhari

doi:10.18203/2320-1770.ijrcog20253919

Authors

Sadanand Karandikar Department of Medical Oncology, Ruby Hall Clinic, Pune, Maharashtra, India
Himanshi Joon Department of Medical Oncology, Ruby Hall Clinic, Pune, Maharashtra, India
Shailesh Puntambekar Department of Surgical Oncology, Galaxy Care Hospital, Pune, Maharashtra, India
Amit Nehra Department of Surgical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India
Vivek Chaudhari Department of Pharmacology, Sayre Therapeutics, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253919

Keywords:

BRCA reversion, Carcinoma ovary, Platinum resistance, Liquid biopsy, Parp inhibitors resistance

Abstract

Herein, this report presents the case of a 48-year-old female with a history of breast cancer (2013) and subsequent high-grade epithelial ovarian cancer (2020), illustrating the complex evolution of therapeutic resistance in BRCA1-mutated malignancies. Following initial response to paclitaxel-carboplatin chemotherapy and complete surgical debulking, the patient experienced multiple disease relapses transitioning from platinum-sensitive to platinum-resistant states. Comprehensive molecular profiling via Tempus xF+ next-generation sequencing revealed a pathogenic BRCA1 mutation alongside a secondary BRCA1 reversion mutation, conferring partial restoration of homologous recombination repair and resistance to both platinum-based chemotherapy and PARP inhibitors. Subsequent therapies, including pemetrexed and liposomal irinotecan, were employed with limited success. This case underscores the dynamic molecular evolution of recurrent ovarian cancer under therapeutic pressure and highlights the critical role of serial genomic profiling in guiding personalized treatment strategies. Emerging approaches targeting alternative DNA repair mechanisms and novel antibody–drug conjugates may hold promise for overcoming resistance in BRCA-mutated, therapy-refractory ovarian cancer.

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