ASCO Living Guideline Addresses Systemic Treatment of Recurrent Ovarian Cancer

ASCO’s living guideline addresses systemic treatment of recurrent high-grade serous and/or endometrioid epithelial ovarian, fallopian tube, and primary peritoneal cancer. An expert panel identified 819 publications and retained 147 publications of randomized controlled trials and systematic reviews, of which 36 directly informed recommendations.

For platinum-sensitive recurrence, clinicians should offer carboplatin combined with pegylated liposomal doxorubicin (PLD), paclitaxel, or gemcitabine. Bevacizumab may be added to a platinum-based doublet and continued as maintenance. Patients unsuitable for platinum therapy may be treated according to recommendations for first-line treatment of relapsed platinum-resistant disease.

For platinum-resistant or platinum-refractory high-grade disease with validated folate receptor alpha expression, mirvetuximab soravtansine is strongly recommended. Other recommended systemic options include PLD alone, paclitaxel weekly or every three weeks, bevacizumab plus chemotherapy, or relacorilant plus nab-paclitaxel. Gemcitabine monotherapy is a conditional alternative. The abstract does not report comparative effect sizes or safety estimates.

Evidence is insufficient to recommend secondary cytoreduction or hyperthermic intraperitoneal chemotherapy, although secondary cytoreduction may be discussed for platinum-sensitive recurrence when complete gross resection is highly achievable. Monitoring and specialty survivorship care should be individualized. The guideline is reviewed every eight weeks, and the supplied abstract explicitly states that this version has been updated; clinicians should consult the online dynamic version before applying these recommendations.