Case Report: Bevacizumab combined with chemotherapy followed by PARP inhibitor maintenance therapy in POLE-mutated primary fallopian tube carcinoma: a case of precision treatment in a rare gynecologic malignancy

Abstract

Background: Primary fallopian tube carcinoma (PTC) is a rare epithelial malignancy of gynecologic origin. The adenosquamous carcinoma variant with POLE mutations is particularly uncommon, and current treatment strategies are limited by its elusive pathogenesis. Given similarities in biological behavior and clinical characteristics to ovarian cancer, PTC staging and management follow ovarian cancer guidelines. Previous studies suggest that anti-angiogenic therapy and poly (ADP-ribose) polymerase (PARP) inhibitors may be potential therapeutic options.

Case presentation: We report a case of bilateral PTC exhibiting histologic heterogeneity and a POLE mutation, complicated by pelvic recurrence with bilateral lung metastases and sigmoid colon involvement. Partial response (PR) was achieved after six cycles of albumin-bound paclitaxel plus carboplatin (nab-TC) combined with bevacizumab (Bev), followed by maintenance therapy with the PARP inhibitor niraparib.

Conclusion: This case demonstrates that Bev combined with chemotherapy may be an effective first-line regimen for this rare PTC variant. Maintenance therapy with a PARP inhibitor may prolong progression-free survival.

Keywords: POLE mutation; adenosquamous carcinoma; anti-angiogenic therapy; fallopian tube carcinoma; niraparib.