A 55-year-old postmenopausal woman undergoes surgery for a 12 cm ovarian mass with bilateral involvement, ascites, and peritoneal deposits in the omentum. Final histopathology shows high-grade serous carcinoma of ovary. BRCA mutation testing is planned. According to FIGO 2014 staging, the stage is IIIC. What is the current first-line chemotherapy regimen according to ICON7/GOG 218 trials?

• A Carboplatin + Paclitaxel alone for 6 cycles
• B Carboplatin + Paclitaxel + Bevacizumab (during and maintenance) ✓
• C Carboplatin + Gemcitabine + PARP inhibitor (Olaparib) maintenance
• D Cisplatin + Cyclophosphamide for 8 cycles

Explanation

ICON7 and GOG 218 trials established that adding bevacizumab (anti-VEGF monoclonal antibody) to standard carboplatin-paclitaxel chemotherapy and continuing as maintenance improved progression-free survival in advanced (stage IIIC-IV) ovarian cancer. The current ESMO/NCCN guideline recommends carboplatin-paclitaxel + bevacizumab for high-risk stage III-IV disease, with bevacizumab maintenance for 15-22 cycles. If BRCA mutated, PARP inhibitor maintenance (olaparib) is added after platinum-based chemotherapy. Carboplatin-paclitaxel alone remains standard for lower-risk cases.

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

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Written and medically reviewed by the StethoPrep medical team.