A 55-year-old woman with stage IIIC epithelial ovarian cancer (serous high-grade) undergoes optimal cytoreductive surgery followed by carboplatin and paclitaxel chemotherapy. She achieves complete remission. Genetic testing reveals BRCA1 germline mutation. Which maintenance therapy, supported by the SOLO-1 trial, is most appropriate to significantly reduce recurrence?
- A Olaparib (PARP inhibitor) ✓
- B Bevacizumab (anti-VEGF monoclonal antibody)
- C Cisplatin-based intraperitoneal chemotherapy
- D Hormone replacement therapy with letrozole
Explanation
The SOLO-1 trial (NEJM 2018) demonstrated that olaparib maintenance therapy for 2 years in newly diagnosed advanced-stage (III/IV) high-grade serous ovarian cancer with BRCA1/2 mutations (germline or somatic) after complete or partial response to platinum-based chemotherapy reduced the risk of disease progression or death by 70% (HR 0.30). Olaparib is a PARP inhibitor that exploits synthetic lethality in BRCA-deficient cells by blocking the PARP-mediated base excision repair pathway. BRCA1/2 mutations impair homologous recombination, making cells dependent on PARP for survival—blocking both pathways causes cell death. Bevacizumab has benefit in PAOLA-1 but less so without BRCA mutation.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.