Effectiveness of azacytidine for poly ADP-ribose polymerase inhibitor-induced myelodysplastic syndrome in ovarian cancer patient: a twofold triumph

Ovarian cancer is characterised by a high mortality rate. Standard of care treatment is based on upfront debulking surgery followed by platinum-based chemotherapy. Currently, the majority of patients in response to platinum agents could benefit from maintenance treatment with poly ADP ribose polymerase inhibitors (PARPi). PARPi may cause rare but potentially life-threatening toxicities such as myelodysplastic syndrome (MDS) and acute myeloid leukaemia (AML). Azacytidine is a demethylating agent that configures as a mainstay of treatment for MDS. It also showed clinical efficacy for platinum-resistant ovarian cancer treatment in preclinical and early clinical trials. We report the case of a patient with advanced ovarian cancer who developed MDS after treatments with PARPi, platinum and anthracycline. She received azacytidine for MDS, achieving both hematologic remission and ovarian cancer regression.