Biomarker-Directed Therapy Across Lines in Ovarian Cancer

Authored by Kathleen Moore, published on 2026-06-28 09:36:17.0

  1. Epithelial ovarian / fallopian tube / primary peritoneal cancer
    • Ensure comprehensive biomarker testing
      • Define disease setting
        • Newly diagnosed / front-line setting
          • BRCA and HRD status
            • Guide first-line maintenance strategy
              • Monitor biomarker-specific toxicity, response, and quality of life
                • At progression: reassess histology, prior exposure, molecular profile, trial eligibility, access, and goals of care
        • Recurrent / later-line setting
          • Review prior therapy, platinum-free interval, and prior biomarker-directed treatment
            • Biomarker-directed treatment selection
              • NTRK fusion
                • Consider TRK inhibitor
                  • Monitor biomarker-specific toxicity, response, and quality of life
                    • At progression: reassess histology, prior exposure, molecular profile, trial eligibility, access, and goals of care
              • Cyclin E1 overexpression / CCNE1 amplification
                • Consider CDK2 inhibitor clinical trial
                  • Monitor biomarker-specific toxicity, response, and quality of life
                    • At progression: reassess histology, prior exposure, molecular profile, trial eligibility, access, and goals of care
              • BRCA mutation / HRD positive
                • Consider PARP inhibitor role based on line, prior PARPi, platinum sensitivity, and access
                  • Monitor biomarker-specific toxicity, response, and quality of life
                    • At progression: reassess histology, prior exposure, molecular profile, trial eligibility, access, and goals of care
              • No actionable biomarker
                • Standard pathway or clinical trial
                  • Monitor biomarker-specific toxicity, response, and quality of life
                    • At progression: reassess histology, prior exposure, molecular profile, trial eligibility, access, and goals of care
              • MSI-H / dMMR or TMB-high
                • Consider immune checkpoint inhibitor strategy if appropriate / approved
                  • Monitor biomarker-specific toxicity, response, and quality of life
                    • At progression: reassess histology, prior exposure, molecular profile, trial eligibility, access, and goals of care
              • HER2 IHC 3+
                • Consider trastuzumab deruxtecan if appropriate / available
                  • Monitor biomarker-specific toxicity, response, and quality of life
                    • At progression: reassess histology, prior exposure, molecular profile, trial eligibility, access, and goals of care
              • FRα high
                • Consider mirvetuximab soravtansine if platinum-resistant and eligible
                  • Monitor biomarker-specific toxicity, response, and quality of life
                    • At progression: reassess histology, prior exposure, molecular profile, trial eligibility, access, and goals of care
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