A 55-year-old woman treated for Stage IIIC high-grade serous ovarian carcinoma with optimal debulking and paclitaxel-carboplatin achieves complete clinical remission. CA-125 normalises. Which maintenance therapy has the strongest evidence to improve progression-free survival in BRCA1/2-mutated patients?

• A Bevacizumab alone
• B Continuation of carboplatin for 6 additional cycles
• C Hormonal therapy with letrozole
• D Olaparib (PARP inhibitor) alone ✓

Explanation

Olaparib, a PARP inhibitor, significantly improves progression-free survival as maintenance therapy in BRCA1/2-mutated advanced ovarian cancer following platinum-based chemotherapy (SOLO-1 trial: PFS benefit >3 years vs placebo). PARP inhibitors exploit homologous recombination deficiency in BRCA-mutated tumours. Bevacizumab benefits unselected patients but the magnitude is smaller; combined olaparib + bevacizumab is used in HRD-positive patients.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.