Durable complete remission of pulmonary metastases with bevacizumab plus olaparib maintenance therapy in homologous recombination-deficient gynecologic large-cell neuroendocrine carcinoma: A case report.

Gynecologic neuroendocrine carcinoma (NEC) is a rare and aggressive malignancy with limited treatment options and poor prognosis. Homologous recombination deficiency (HRD) is an established predictive biomarker for poly(ADP-ribose) polymerase (PARP) inhibitor response in ovarian cancer, but its clinical relevance in NEC remains unclear. Case presentation A 71-year-old woman presented with a large pelvic mass and multiple pulmonary metastases. Primary debulking surgery was performed, and histopathology revealed large-cell NEC (LCNEC) of presumed gynecologic origin. Postoperatively, the patient received paclitaxel-carboplatin plus bevacizumab. HRD testing demonstrated a high genomic instability score without BRCA1/2 mutations. After six cycles of chemotherapy, the pulmonary lesions showed a partial response. Maintenance therapy with bevacizumab plus olaparib was initiated, and the patient achieved complete radiologic remission, remaining disease-free for 1 year. Conclusion HRD-positive gynecologic NEC may respond to PARP inhibitor-based therapy even in the absence of BRCA mutations. HRD assessment may help identify patients with NEC who could benefit from targeted treatment strategies.