Management of Platinum-Resistant and Later-Line Ovarian Cancer

Authored by Kathleen Moore, published on 2026-06-28 09:43:36.0

  1. Recurrent epithelial ovarian / fallopian tube / primary peritoneal cancer
    • Confirm prior platinum exposure and current line of therapy
      • Determine platinum-free interval (PFI)
        • PFI > 6 months
          • Platinum-sensitive recurrence
            • Consider platinum re-treatment if appropriate
              • If platinum inappropriate: use non-platinum / biomarker-directed options
                • Review biomarkers and prior exposure
                  • Cyclin E1 overexpression / CCNE1 amplification
                    • CDK2 inhibitor clinical trial
                      • Monitor toxicity, response, symptoms, and goals of care
                        • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                  • No actionable biomarker or preferred option unavailable
                    • Bevacizumab + chemotherapy or single-agent chemotherapy
                      • Monitor toxicity, response, symptoms, and goals of care
                        • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                  • Clinical trial available
                    • Strongly consider clinical trial
                      • Monitor toxicity, response, symptoms, and goals of care
                        • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                  • HER2 IHC 3+
                    • Trastuzumab deruxtecan
                      • Monitor toxicity, response, symptoms, and goals of care
                        • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                  • Prior bevacizumab and no prior weekly taxane
                    • Nab-paclitaxel + relacorilant if available / approved
                      • Monitor toxicity, response, symptoms, and goals of care
                        • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                  • PD-L1 positive and no prior weekly taxane
                    • Weekly paclitaxel + bevacizumab + pembrolizumab
                      • Monitor toxicity, response, symptoms, and goals of care
                        • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                  • FRb1 high and no prior MIRV
                    • Mirvetuximab soravtansine
                      • Monitor toxicity, response, symptoms, and goals of care
                        • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
        • PFI 3–6 months
          • Partially platinum-sensitive / resistant spectrum
            • Prioritize biomarker-directed and non-platinum options
              • Review biomarkers and prior exposure
                • Cyclin E1 overexpression / CCNE1 amplification
                  • CDK2 inhibitor clinical trial
                    • Monitor toxicity, response, symptoms, and goals of care
                      • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                • No actionable biomarker or preferred option unavailable
                  • Bevacizumab + chemotherapy or single-agent chemotherapy
                    • Monitor toxicity, response, symptoms, and goals of care
                      • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                • Clinical trial available
                  • Strongly consider clinical trial
                    • Monitor toxicity, response, symptoms, and goals of care
                      • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                • HER2 IHC 3+
                  • Trastuzumab deruxtecan
                    • Monitor toxicity, response, symptoms, and goals of care
                      • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                • Prior bevacizumab and no prior weekly taxane
                  • Nab-paclitaxel + relacorilant if available / approved
                    • Monitor toxicity, response, symptoms, and goals of care
                      • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                • PD-L1 positive and no prior weekly taxane
                  • Weekly paclitaxel + bevacizumab + pembrolizumab
                    • Monitor toxicity, response, symptoms, and goals of care
                      • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
                • FRb1 high and no prior MIRV
                  • Mirvetuximab soravtansine
                    • Monitor toxicity, response, symptoms, and goals of care
                      • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
        • PFI < 3 months or progression on platinum
          • Platinum-resistant disease
            • Review biomarkers and prior exposure
              • Cyclin E1 overexpression / CCNE1 amplification
                • CDK2 inhibitor clinical trial
                  • Monitor toxicity, response, symptoms, and goals of care
                    • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
              • No actionable biomarker or preferred option unavailable
                • Bevacizumab + chemotherapy or single-agent chemotherapy
                  • Monitor toxicity, response, symptoms, and goals of care
                    • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
              • Clinical trial available
                • Strongly consider clinical trial
                  • Monitor toxicity, response, symptoms, and goals of care
                    • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
              • HER2 IHC 3+
                • Trastuzumab deruxtecan
                  • Monitor toxicity, response, symptoms, and goals of care
                    • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
              • Prior bevacizumab and no prior weekly taxane
                • Nab-paclitaxel + relacorilant if available / approved
                  • Monitor toxicity, response, symptoms, and goals of care
                    • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
              • PD-L1 positive and no prior weekly taxane
                • Weekly paclitaxel + bevacizumab + pembrolizumab
                  • Monitor toxicity, response, symptoms, and goals of care
                    • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
              • FRb1 high and no prior MIRV
                • Mirvetuximab soravtansine
                  • Monitor toxicity, response, symptoms, and goals of care
                    • At progression: reassess biomarkers, prior exposure, toxicity, access, trial eligibility, and goals of care
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