A 68-year-old woman presents with Stage IIIC high-grade serous ovarian cancer. She undergoes upfront debulking surgery achieving complete cytoreduction (R0, no visible residual disease). CA-125 normalises after 3 cycles of carboplatin-paclitaxel. After completing 6 cycles, she is BRCA1 wild-type and HRD-negative. According to current evidence (SOLO1, PRIMA, PAOLA-1 trials), which maintenance strategy has Level 1 evidence for improving PFS in her specific molecular profile?
- A Bevacizumab maintenance (ICON7/GOG-0218 trials) ✓
- B Olaparib maintenance for 2 years (SOLO1 indication)
- C Niraparib maintenance regardless of BRCA status (PRIMA trial)
- D Observation — no maintenance therapy has proven benefit in HRD-negative BRCA wild-type patients
Explanation
In BRCA wild-type, HRD-negative advanced ovarian cancer, PARP inhibitors (olaparib, niraparib) have significantly less benefit — the PRIMA trial showed PFS benefit for niraparib in all patients but was substantially diminished in the HRD-negative subgroup. The most established maintenance option for HRD-negative patients is bevacizumab, particularly in high-risk Stage III/IV disease (ICON7, GOG-0218, PAOLA-1). SOLO1 is specifically for BRCA-mutated Stage III/IV patients in CR/PR after first-line platinum. Thus bevacizumab is the evidence-based choice for this HRD-negative patient.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.