The American Society of Clinical Oncology (ASCO) has published its first living guideline on the systemic treatment of recurrent high-grade serous and/or endometrioid epithelial ovarian, fallopian tube, or primary peritoneal cancer (EOC), and it has been published in the Journal of Clinical Oncology.¹
A multidisciplinary expert panel screened 819 publications; 147 randomized controlled trials and systematic reviews formed the evidentiary basis, and 36 directly informed the final recommendations. The guideline includes 17 recommendations across 6 research questions covering systemic therapy, maintenance therapy, surgery, and post-treatment monitoring for platinum-sensitive and platinum-resistant or platinum-refractory disease.¹
“The goal of the guideline is to provide the evidence behind standard-of-care treatments for recurrent ovarian cancer that are comprehensive, literature-based, and accessible,” expert panel co-chair Jamie L. Lesnock, MD, said.²
First Living Guideline on Systemic Treatment of Recurrent Ovarian Cancer: Top Takeaways
- ASCO's first-ever living guideline on recurrent ovarian cancer is built on a systematic review of 819 screened publications, with 36 trials directly shaping the 17 final recommendations.
- Platinum-based doublets remain the backbone for platinum-sensitive recurrence, with bevacizumab maintenance offering a PFS benefit but no proven OS gain.
- For platinum-resistant or platinum-refractory disease, mirvetuximab soravtansine (Elahere) is now preferred for FRα-positive tumors, while relacorilant (Lifyorli) plus nab-paclitaxel (Abraxane) offers a newly approved option that requires no biomarker testing.
Lesnock is affiliated with UPMC Magee-Womens Hospital in Pittsburgh, Pennsylvania. Co-chair Jennifer M. Scalici, MD, of Emory University in Atlanta, Georgia, added that management of EOC has become more complicated as biomarker-driven therapeutics enter standard paradigms, noting that “how and when to use them...is not always clear.”²
What does the guideline recommend for platinum-sensitive recurrent ovarian cancer?
For patients with recurrent platinum-sensitive epithelial ovarian cancer (PSOC), defined as recurrence more than 6 months from last platinum exposure, the panel strongly recommends platinum-based doublets: pegylated liposomal doxorubicin (PLD) plus carboplatin (evidence quality, low), paclitaxel plus carboplatin (moderate), or gemcitabine plus carboplatin (moderate; conditional recommendation).¹ Bevacizumab (Avastin) could be added to a platinum-based doublet followed by bevacizumab maintenance (moderate; strong), a recommendation supported by the phase 3 OCEANS trial (NCT00434642), which showed improved progression-free survival (PFS) with bevacizumab plus gemcitabine-carboplatin (HR, 0.48; 95% CI, 0.39-0.61) without a significant overall survival (OS) benefit. The panel recommends against adding trabectedin (Yondelis) to PLD, citing a lack of efficacy benefit across 2 studies and probable worsening of treatment-related adverse effects (TRAEs).
What is the role of maintenance therapy and surgery in platinum-sensitive disease?
The panel conditionally recommends maintenance bevacizumab for patients with PSOC who have responded to platinum-based therapy in combination with bevacizumab (moderate evidence quality; strong recommendation), based on 4 randomized trials showing improved PFS, including the 682-patient, phase 3 AGO-OVAR 2.21/ENGOT-ov18 trial (NCT01837251; HR, 0.81; 95% CI, 0.68-0.96) and a 406-patient, phase 3 MITO16b/MANGO-OV2/ENGOT-ov17 trial (NCT01802749; HR, 0.51; 95% CI, 0.41-0.65). For secondary cytoreductive surgery, the panel found insufficient evidence or agreement to recommend for or against the intervention, citing mixed results across 3 randomized trials, although clinicians may discuss surgery for patients with a high likelihood of complete gross resection. Similarly, there is insufficient evidence to recommend for or against hyperthermic intraperitoneal chemotherapy (HIPEC) at recurrence, and the panel states this approach should not be used outside experienced centers or clinical trials.
What is recommended for platinum-resistant or platinum-refractory ovarian cancer?
For patients with recurrent platinum-resistant or platinum-refractory EOC (PROC), the panel strongly recommends mirvetuximab soravtansine-gynx (Elahere) for those with high-grade disease and validated folate receptor alpha (FRα) expression by immunohistochemistry (≥75% of cells with 2+ or 3+ staining intensity; high evidence quality). This recommendation draws on the phase 3 MIRASOL trial (NCT04209855), which showed improved PFS (HR, 0.72; 95% CI, 0.56-0.92) and OS (HR, 0.67; 95% CI, 0.50-0.89) with mirvetuximab soravtansine vs chemotherapy in FRα-high PROC.
Additional strong recommendations include PLD monotherapy, bevacizumab in combination with chemotherapy, and paclitaxel administered weekly or once every 3 weeks. The panel conditionally recommends relacorilant (Lifyorli) plus nab-paclitaxel (Abraxane), based on the phase 3 ROSELLA trial (NCT05257408), which reported improved PFS (HR, 0.70; 95% CI, 0.54-0.91) and OS (HR, 0.65; 95% CI, 0.51-0.83) vs nab-paclitaxel alone, and gemcitabine monotherapy as a conditional alternative. The panel found insufficient evidence to recommend for or against cytoreductive surgery in patients with PROC.
What monitoring strategy does the guideline recommend after treatment for recurrent disease?
The panel conditionally recommends clinical follow-up for patients with PSOC after completion of anticancer treatment (low evidence quality) and ongoing specialty survivorship care for patients with PROC who have received frontline treatment (very low evidence quality). These recommendations draw on a Cochrane systematic review and 2 randomized trials showing no OS benefit from early treatment triggered by rising CA-125 levels, along with some negative effects on quality-of-life end points.
The guideline notes that a separate ASCO guideline on PARP inhibitors in ovarian cancer is pending an update, and it flags emerging evidence on pembrolizumab (Keytruda) plus paclitaxel with or without bevacizumab, which the FDA approved in February 2026 for a PD-L1–selected platinum-resistant population based on the phase 3 KEYNOTE-B96 trial (NCT05116189).
References
- Lesnock JL, Temin S, Bouberhan S, et al. Systemic treatment of ovarian cancer recurrence: ASCO living guideline, version 2026.1.0. J Clin Oncol. Published online August 24, 2026. doi:10.1200/JCO-26-01591
- ASCO issues first living guideline for recurrent ovarian cancer treatment. News release. American Society of Clinical Oncology. August 30, 2026. Accessed September 14, 2026. https://dailynews.ascopubs.org/do/asco-issues-first-living-guideline-systemic-treatment-recurrent-ovarian-cancer
