A 60-year-old woman undergoes cytoreductive surgery for high-grade serous ovarian carcinoma (Stage IIIC). She achieves R0 resection. She is BRCA2 mutated. What maintenance therapy has demonstrated the greatest improvement in progression-free survival in this setting?
- A Bevacizumab maintenance for 15 months
- B Weekly paclitaxel maintenance for 12 months
- C PARP inhibitor (olaparib or niraparib) maintenance after platinum-based chemotherapy ✓
- D Hormonal suppression with letrozole
Correct answer: C. PARP inhibitor (olaparib or niraparib) maintenance after platinum-based chemotherapy
Explanation
PARP inhibitors (olaparib, niraparib, rucaparib) exploit synthetic lethality in BRCA-mutated tumours (deficient in homologous recombination). In BRCA1/2 mutated newly-diagnosed ovarian cancer after platinum response, olaparib maintenance (SOLO-1 trial) extended PFS by >3 years (median PFS not reached vs 13.8 months placebo). This represents the single largest PFS benefit in ovarian cancer maintenance. Bevacizumab improves PFS modestly across all patients; weekly paclitaxel and letrozole are not standard first-line maintenance.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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