Systemic Treatment of Ovarian Cancer Recurrence: ASCO Living Guideline, Version 2026.1.0

To provide guidance regarding the systemic treatment of patients with high-grade serous and/or endometrioid epithelial ovarian, fallopian tube, or primary peritoneal cancer (EOC) experiencing recurrence.

ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice.

Eight hundred nineteen publications were identified in the literature search. After applying the eligibility criteria, 147 publications of randomized controlled trials and systematic reviews comprising the entire body of evidence remained, forming the evidentiary basis, of which 36 directly informed the guideline recommendations.

For patients with recurrent platinum-sensitive EOC, clinicians should offer platinum-based combination regimens, specifically pegylated liposomal doxorubicin (PLD) plus carboplatin, paclitaxel plus carboplatin, or gemcitabine plus carboplatin. Bevacizumab may be added to a platinum-based doublet followed by bevacizumab maintenance. For patients who are not candidates for platinum-based therapy, clinicians may utilize recommendations for first-line treatment of patients with relapsed platinum-resistant disease. For patients with platinum-resistant or platinum-refractory EOC high-grade disease and validated folate receptor alpha (FRα) expression, mirvetuximab soravtansine is strongly recommended. Other recommended systemic options for this population include PLD monotherapy, paclitaxel (once weekly or once every 3 weeks), bevacizumab in combination with chemotherapy, or the combination of relacorilant and nab-paclitaxel; gemcitabine monotherapy remains a conditional alternative. Regarding surgical interventions, there is currently insufficient evidence to recommend secondary cytoreduction or hyperthermic intraperitoneal chemotherapy. Clinicians may discuss secondary cytoreduction for platinum-sensitive recurrences where complete gross resection is highly achievable. Post-treatment monitoring and specialty survivorship care should be offered on a case-by-case basis, potentially including physical exams, biochemical testing, and imaging. There is insufficient data to recommend one combination versus another.Additional information is available on the ASCO Publications website.Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients.Clinical Practice Guidelines and other guidance ("Guidance") provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases, or stages of diseases. Guidance is based on review and analysis of relevant literature and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in the Appendix (online only) for more.