A 70-year-old woman presents with abdominal distension and postmenopausal bleeding. CA-125 is 890 U/mL. CT shows bilateral ovarian masses with omental caking. Ascites is drained and cytology confirms adenocarcinoma. The most appropriate initial chemotherapy regimen for advanced high-grade serous ovarian cancer is:

• A Paclitaxel + carboplatin ✓
• B Cisplatin + cyclophosphamide
• C Bevacizumab monotherapy
• D Liposomal doxorubicin + carboplatin

Explanation

The standard first-line chemotherapy for advanced high-grade serous ovarian cancer is paclitaxel + carboplatin (every 3 weeks), established by the GOG-158 and ICON3 trials. Bevacizumab may be added for high-risk stage III/IV disease (GOG-218, ICON7) but not as monotherapy. Cisplatin/cyclophosphamide is the older regimen superseded by paclitaxel/carboplatin. Liposomal doxorubicin is used in recurrent disease.

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

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Written and medically reviewed by the StethoPrep medical team.