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

Area of Science:

• Gynecologic Oncology
• Medical Oncology
• Clinical Practice Guidelines

Background:

• Recurrent epithelial ovarian cancer (EOC) presents significant treatment challenges.
• Systemic therapy is a cornerstone in managing recurrent EOC.

Purpose of the Study:

• To provide evidence-based guidance on systemic treatment for recurrent high-grade serous and/or endometrioid epithelial ovarian, fallopian tube, or primary peritoneal cancer.
• To update clinical practice recommendations for managing recurrent EOC.

Main Methods:

• Systematic review of 147 publications, including RCTs and systematic reviews.
• Expert Panel convened by ASCO to develop clinical practice recommendations.
• Evidence synthesis from 36 publications directly informing guideline recommendations.

Main Results:

• For platinum-sensitive recurrent EOC, platinum-based combination regimens (e.g., pegylated liposomal doxorubicin plus carboplatin) are recommended.
• For platinum-resistant/refractory EOC with FRα expression, mirvetuximab soravtansine is strongly recommended; other options include PLD monotherapy or bevacizumab combinations.
• Insufficient evidence for secondary cytoreduction or hyperthermic intraperitoneal chemotherapy, though secondary cytoreduction may be considered for select platinum-sensitive cases.

Conclusions:

• Guidance provided for platinum-sensitive and platinum-resistant recurrent EOC systemic treatment.
• Mirvetuximab soravtansine is a key option for FRα-positive platinum-resistant/refractory EOC.
• Further research is needed to compare specific treatment combinations and surgical interventions.