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Gynaecology: Ovarian — first-line adjuvant chemotherapy and maintenance

Free question published 18 September 2026

GynaecologyOvarian — first-line adjuvant chemotherapy and maintenance

A 58-year-old woman has undergone optimal cytoreductive surgery for FIGO stage IIIC high-grade serous ovarian carcinoma. Germline testing confirms a pathogenic BRCA1 mutation. She has completed six cycles of carboplatin and paclitaxel with a complete radiological response. What maintenance strategy is best supported by the evidence?

  1. ASurveillance with no maintenance therapy
  2. BOlaparib maintenance
  3. CTamoxifen maintenance
  4. DWhole-abdominal radiotherapy
  5. EA further six cycles of carboplatin and paclitaxel

Why B is correct

In a BRCA-mutated patient responding to first-line platinum chemotherapy, the SOLO-1 trial showed maintenance olaparib markedly improved progression-free survival (hazard ratio 0.30; 95% CI 0.23-0.41). The ESMO guideline recommends PARP inhibitor maintenance after response to first-line platinum-based chemotherapy, with olaparib for BRCA-mutated disease.

And why the others are not

  • AIncorrect. Surveillance forgoes the substantial progression-free survival benefit of PARP inhibitor maintenance in this BRCA-mutated patient.
  • CIncorrect. Tamoxifen is not standard maintenance for high-grade serous ovarian cancer in this setting.
  • DIncorrect. Whole-abdominal radiotherapy is not standard maintenance and carries excess toxicity.
  • EIncorrect. Extending platinum chemotherapy beyond six cycles is not recommended and would not match the SOLO-1 strategy.

Source SOLO-1 — maintenance olaparib in newly diagnosed BRCA-mutated advanced ovarian cancer — Moore K, Colombo N, Scambia G, et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med, 2018.

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