A 38-year-old woman with previously treated Stage III ovarian cancer (platinum-sensitive relapse at 18 months) is being considered for second-line therapy. Genetic testing shows germline BRCA2 mutation. After carboplatin-based chemotherapy achieves response, which maintenance therapy has demonstrated the greatest improvement in progression-free survival in this patient profile?
- A Bevacizumab (anti-VEGF antibody) maintenance
- B Weekly paclitaxel consolidation
- C PARP inhibitor (olaparib) maintenance ✓
- D Tamoxifen hormonal maintenance
Explanation
PARP inhibitors (olaparib, niraparib, rucaparib) exploit synthetic lethality in BRCA-mutated tumours by blocking the base excision repair pathway, causing irreparable double-strand DNA breaks in tumour cells lacking functional homologous recombination. The SOLO2 trial (Lancet Oncology 2017) demonstrated that olaparib maintenance after platinum-sensitive relapse in BRCA1/2-mutated ovarian cancer extended median PFS from 5.5 to 19.1 months. For BRCA2-mutated platinum-sensitive relapsed ovarian cancer, olaparib maintenance has the strongest trial evidence and is the standard of care.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.