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

Abstract

PURPOSE 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. METHODS ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS 819 publications were identified in the literature search. After applying the eligibility criteria, 147 publications of RCTs and systematic reviews comprising the entire body of evidence remained, forming the evidentiary basis, of which 36 directly informed the guideline recommendations. 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 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 three 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 .