ASCO Issues First Living Guideline for Recurrent Ovarian Cancer Treatment

The American Society of Clinical Oncology (ASCO) has issued its first living guideline on the systemic treatment of high grade epithelial ovarian, fallopian tube, or primary peritoneal cancer experiencing recurrence, according to a press release from ASCO and the guideline published in the Journal of Clinical Oncology.^1,2 They were developed by a multidisciplinary expert panel that screened 819 publications, of which 147 randomized controlled trials and systematic reviews formed the evidentiary basis and 36 directly informed the final recommendations.

The recommendations include platinum-based combination regimens for patients with platinum-sensitive disease and a sequence of non-platinum options, including mirvetuximab soravtansine-gynx (Elahere) for a biomarker-selected subgroup, for those with platinum-resistant or platinum-refractory disease.

“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,” stated expert panel co-chair Jamie Lesnock, MD, of the University of Pittsburgh Medical Center.²

What does the guideline recommend for platinum-sensitive recurrence?

For patients with recurrent platinum-sensitive epithelial ovarian cancer, the panel strongly recommends platinum-based doublets, including pegylated liposomal doxorubicin (PLD) plus carboplatin, paclitaxel plus carboplatin, or gemcitabine plus carboplatin. Bevacizumab (Avastin) may be added to a platinum-based doublet followed by bevacizumab maintenance, a strategy the panel found consistently prolongs progression-free survival (PFS) by approximately 4 months without a consistent overall survival (OS) benefit.

The panel recommends against adding trabectedin (Yondelis) to PLD and stated there is insufficient evidence to recommend for or against secondary cytoreduction or hyperthermic intraperitoneal chemotherapy (HIPEC) in this population, though secondary cytoreduction may be discussed when complete gross resection appears achievable.

What does the guideline recommend for platinum-resistant recurrence?

For platinum-resistant or platinum-refractory ovarian cancer, the panel strongly recommends mirvetuximab soravtansine for patients with high-grade disease and validated folate receptor alpha (FRα) expression by immunohistochemistry, based on OS and PFS benefits demonstrated in the phase 3 MIRASOL trial (NCT04209855).³ Other strongly recommended options include PLD monotherapy, bevacizumab plus chemotherapy, and paclitaxel on either a weekly or every-3-week schedule. The combination of relacorilant (Lifyorli) and nab-paclitaxel received a conditional recommendation based on data from the phase 3 ROSELLA trial (NCT05257408).⁴ Gemcitabine monotherapy remained a conditional alternative, and the panel found insufficient evidence to recommend cytoreductive surgery in this population.

What is the role of monitoring after treatment?

The panel conditionally recommends clinical follow-up for patients with platinum-sensitive recurrence and ongoing specialty survivorship care for those with platinum-resistant disease following first-line treatment, citing low- and very-low-quality evidence, respectively. A Cochrane review and associated randomized trials found no OS benefit from early treatment triggered by rising CA-125 levels, and the panel noted this approach may decrease quality of life without improving survival. Options for monitoring, including history and physical exam, pelvic exam, biochemical testing, and imaging, should be individualized through shared decision-making.

How was the guideline developed?

The living guideline update process, distinct from a full guideline revision, will undergo formal review of emerging literature every 8 weeks by the standing expert panel to determine whether updates are warranted, according to the ASCO Guidelines Methodology Manual.¹ Draft recommendations underwent a public comment period from December 18, 2025, through January 16, 2026, during which 88% of 45 respondents agreed or agreed with slight modifications.

The panel noted several limitations, including heterogeneous platinum-sensitivity definitions across trials and a paucity of data on therapeutic sequencing at recurrence, and flagged a pending update addressing poly(ADP-ribose) polymerase inhibitors in this setting.

“Our intention is that this guideline serves as a framework for epithelial ovarian cancer from which a full spectrum of oncology providers can base their decision-making,” added expert panel co-chair Jennifer Scalici, MD, of Emory University.² “Treating epithelial ovarian cancer has…become more complicated as more novel therapeutics are being integrated into the standard treatment paradigms and [oncologists] become more biomarker driven. This is a good problem to have as more treatment options are available to our patients. How and when to use them, however, is not always clear.”

References

1. 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 July 13, 2026. doi:10.1200/JCO-26-01591
2. ASCO issues its first living guideline on systemic treatment of recurrent ovarian cancer. News release. ASCO. August 24, 2026. Accessed August 28, 2026. https://tinyurl.com/429nrub4
3. Van Gorp T, Angelergues A, Konecny G, et al. Final overall survival analysis among patients with FRα-positive, platinum-resistant ovarian cancer (PROC) treated with mirvetuximab soravtansine (MIRV) vs investigator’s choice chemotherapy (ICC) in the phase 3 MIRASOL (GOG 3045/ENGOT-ov55) study. Presented at: 2025 SGO Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Abstract 939696.
4. Olawaiye AB, Quesada S, Gilbert L, et al. Final overall survival results from the phase 3 ROSELLA trial: relacorilant plus nab-paclitaxel vs nab-paclitaxel monotherapy in patients with platinum-resistant ovarian cancer. Presented at: 2026 SGO Annual Meeting; April 10-13, 2026; San Juan, Puerto Rico.