A 62-year-old woman with Stage IIIC high-grade serous ovarian carcinoma (HGSOC) completes 6 cycles of carboplatin-paclitaxel with complete clinical response. BRCA1/2 germline testing returns positive (BRCA1 mutation). According to current ESMO/ASCO guidelines, the most appropriate maintenance strategy is:

• A Bevacizumab (anti-VEGF) maintenance for 15 months based on ICON7 trial data
• B Combined olaparib + bevacizumab maintenance for 2 years based on PAOLA-1 trial
• C Olaparib (PARP inhibitor) maintenance for 2 years based on SOLO-1 trial data ✓
• D Niraparib maintenance regardless of BRCA status based on PRIMA trial data

Explanation

For newly diagnosed Stage III–IV HGSOC with BRCA1/2 mutation achieving complete or partial response after platinum-based chemotherapy, olaparib maintenance for 2 years is the standard of care based on the SOLO-1 trial (Moore et al., 2018), which demonstrated a 70% reduction in risk of disease progression or death (median PFS not reached vs 13.8 months for placebo). While bevacizumab (B, ICON7/OCEANS) and combination olaparib+bevacizumab (C, PAOLA-1) are also valid strategies, for BRCA-mutated patients, olaparib monotherapy has the strongest, most specific evidence with profound PFS benefit. Niraparib (D, PRIMA trial) is for maintenance in all-comer population, not specifically indicated over olaparib in BRCA-mutated patients for first-line.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.