In the management of apparent early-stage (Stage IC–IIA) high-grade serous ovarian cancer, which adjuvant chemotherapy regimen is currently recommended as standard of care and what is the basis for the number of cycles?

• A Carboplatin monotherapy for 3 cycles, adequate for low-volume residual disease
• B Carboplatin/paclitaxel for 3 cycles only if BRCA wild-type, 6 cycles if BRCA mutant
• C Carboplatin/paclitaxel for 6 cycles, based on ACTION and ICON1 meta-analysis showing survival benefit ✓
• D Cisplatin/cyclophosphamide for 6 cycles as platinum doublet remains superior to carboplatin combinations

Explanation

The combined analysis of the ACTION and ICON1 trials (published in JNCI 2003) established that adjuvant platinum-based chemotherapy significantly improves recurrence-free and overall survival in early-stage ovarian cancer (Stage IA–IIA, incompletely staged, or high-grade). Current ESMO and NCCN guidelines recommend 6 cycles of carboplatin (AUC 5–6) plus paclitaxel (175 mg/m²) as standard adjuvant therapy. Three cycles may be considered for Stage IA–IB grade 1 (low risk), but high-grade or Stage IC–IIA disease warrants 6 cycles regardless of BRCA status.

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

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