Secondary acute myeloid leukemia following multi-line chemotherapy for metastatic ovarian neuroendocrine carcinoma in a resource-limited setting: a case report

Background: Ovarian small-cell neuroendocrine carcinomas are extremely rare, high-grade tumors characterized by aggressive behavior and poor prognosis, particularly in metastatic stages. In the absence of standardized therapeutic guidelines, management often relies on empirical strategies, exposing patients to significant cumulative toxicity. Case presentation: We report the case of a 42-year-old woman with no significant medical history who was diagnosed with advanced-stage (pT3N1M1) ovarian small-cell neuroendocrine carcinoma, revealed by pelvic pain and hepatomegaly. Following initial surgery, the patient received four successive lines of palliative chemotherapy (etoposide–carboplatin, GEMOX, irinotecan–cisplatin, and capecitabine). Oncologic benefit remained limited, with only transient disease stabilization, while cumulative hematologic toxicities were substantial. Twenty-three months after the initial diagnosis, the patient developed secondary acute myeloid leukemia arising from a myelodysplastic syndrome, leading to an exclusively palliative approach. The subsequent clinical course was marked by renal failure, thromboembolic complications, and death. Conclusion: This case highlights the limitations of conventional treatments in metastatic ovarian small-cell neuroendocrine carcinoma and underscores the risk of severe hematologic complications associated with cumulative chemotherapy exposure. It emphasizes the importance of a rigorous benefit–risk assessment, early integration of palliative care, and adaptation of therapeutic strategies to the realities of resource-limited settings.