A 45-year-old woman with epithelial ovarian cancer (high-grade serous, Stage IIIC) undergoes optimal debulking surgery followed by carboplatin-paclitaxel. She carries a germline BRCA2 mutation. Which targeted maintenance therapy has shown GREATEST improvement in progression-free survival in this clinical scenario?
- A Olaparib plus bevacizumab combination maintenance ✓
- B Bevacizumab (anti-VEGF) maintenance
- C Olaparib (PARP inhibitor) maintenance monotherapy
- D Pembrolizumab (PD-1 inhibitor) maintenance
Explanation
The PAOLA-1 trial demonstrated that olaparib plus bevacizumab maintenance in BRCA-mutated, HRD-positive high-grade serous ovarian cancer after first-line carboplatin-paclitaxel-bevacizumab nearly tripled median progression-free survival compared to bevacizumab alone (37.2 vs 17.7 months in BRCA-mutant subgroup). PAOLA-1 showed the greatest absolute benefit in BRCA1/2 germline mutations. Olaparib monotherapy (SOLO-1 trial) also shows impressive PFS benefit in BRCA-mutant patients but the combination has even greater benefit particularly when bevacizumab is part of the primary regimen. Pembrolizumab has no approved first-line role in ovarian cancer.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.