Multimodal therapy for ovarian cancer with brain metastases diagnosed synchronously at the initial phase: case report of a long-term survivor with comprehensive literature review.

Brain metastases from epithelial ovarian cancer (EOC) are uncommon and usually occur during disease recurrence. Their occurrence at the initial phase of the disease is particularly rare. Overall prognosis remains poor despite the employment of a multimodal therapy including surgery, radiotherapy and chemotherapy, with reported progression-free survivals of approximately 12 months. The role of targeted therapies in this setting, particularly poly ADP-ribose polymerase inhibitors (PARPi), remains incompletely defined. We report the case of a 45-year-old woman with high-grade serous ovarian carcinoma who developed symptomatic brain metastases 6 days following primary debulking surgery (PDS). A BRCA1 mutation was identified on tumor sequencing and was subsequently confirmed as a germline pathogenic variant. Complete remission was obtained using stereotactic radiotherapy to the brain lesions, followed by platinum-based chemotherapy and maintenance therapy with bevacizumab and olaparib. 45 months since the initiation of olaparib, the patient still has no evidence of disease. PARPi are a promising maintenance therapy to control EOC with secondary brain metastases, particularly in PARPi-naïve disease. Their role in this setting remains emerging and primarily supported by limited case reports and small series. Further studies are required to better define their role.