Clinical Benefit With PARP Inhibitor for Pathogenic Germline FANCA-mutated Relapsed Epithelial Ovarian Cancer: a Case Report

Abstract Background: PARP inhibitors have been approved as targeted therapy for BRCA-deficient metastatic ovarian cancer (OC). Fanconi anemia complementation group A (FANCA) is one of Fanconi anaemia-related genes and a susceptibility gene to breast and OC. However, whether germline FANCA-mutated relapsed epithelial OC could achieve clinical benefit from the treatment of PARP inhibitor is still unclear. Case presentation: A 49-year-old female patient was diagnosed with epithelial OC and underwent resection and first-line of platinum-based chemotherapy in 2016. After first recurrence, she underwent radical resection and received second-line of platinum-based chemotherapy in 2018. After the second relapse in July 2019, the patient underwent radical resection and the corresponding tumor tissue DNA suffered next generation sequencing (NGS) analysis revealed a germline FANCA mutation. Subsequently, the third-line treatment of liposomal doxorubicin hydrochloride plus lobaplatin was administrated for five cycles with patient consent and then oral niraparib (200 mg daily) was administered for maintenance treatment. During the follow-up, no evidence of tumor recurrence was observed. Currently, the PFS already exceeded 21 months and the treatment is still going on. Conclusions: This case highlighted that OC patients harboring with pathogenic gene alterations in homologous recombination pathway might achieved clinical benefit from PARP inhibitors, which should be confirmed in further studies.