In June 2026, an ASCO Expert Panel voted to approve ASCO’s first Living Guideline on systemic treatment of ovarian cancer recurrence.1 The continuously updated, evidence-based guideline addresses patients with epithelial ovarian cancer, primary peritoneal carcinoma, and fallopian tube carcinoma, and patients whose cancers are high-grade serous and/or endometrioid type.
“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,” said Expert Panel Co-Chair Jamie Lesnock, MD, of the University of Pittsburgh Medical Center. Given that ASCO readership encompasses a wide variety of oncology providers—from gynecologic oncologists to medical oncologists, advanced practice providers, and beyond—the hope is that “this guideline will reach the community that treats women with ovarian cancer and will be easily applicable.”
Jamie Lesnock, MD
Jennifer Scalici, MD
“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. “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.”
Dr. Scalici is hopeful that this guideline will provide some structure, context, and rationale behind treatment recommendations and, as a Living Guideline, adapt and evolve with the rapidly shifting treatment landscape.
Recommendations Informed by Systematic Review of Clinical Trials
Dr. Lesnock noted that approximately 75% of women will present with advanced ovarian cancer at the time of diagnosis—stages II through IV—and even though many will achieve remission, approximately 70% to 80% of women will have a recurrence.2,3 “This is a disease that has a high rate of recurrence and a definitive need for guideline-driven therapeutic options,” she said.
The guideline recommendations were developed using a systematic review of literature identified through online searches of PubMed and Cochrane Library for phase II and phase III randomized controlled trials from January 31, 2004, to October 28, 2024, and clinical experience. The evidence base consisted of 147 publications of randomized controlled trials and systematic reviews, of which 36 directly informed the guideline recommendations.
“To keep this document accessible and our recommendations high quality, we limited our review to published randomized controlled trials and systematic reviews of these trials, examining each in detail and interpreting older studies in light of current science and practice,” Dr. Scalici said. “This meant excluding the many exciting early-phase and ongoing studies of new agents now rapidly entering the clinic—including two or three potentially practice-changing trials published within weeks of each other during our drafting phase. If keeping pace with treatment recommendations is this challenging even while writing them, this guideline needs the flexibility to evolve as we ourselves learn how to sequence these agents in practice.”
The Expert Panel is excited about the Living Guideline format, which provides real-time adaptability for oncology providers and patients. The Panel’s current recommendations are the following:1
- For patients with recurrent platinum-sensitive epithelial ovarian cancer, platinum-based combination regimens, specifically pegylated liposomal doxorubin (PLD) plus carboplatin, paclitaxel plus carboplatin, or gemcitabine plus carboplatin, are recommended. Bevacizumab may be added to a platinum-based doublet followed by bevacizumab maintenance.
- For patients who are not candidates for platinum-based therapy, the clinicians should follow the recommendations for first-line treatment of patients with relapsed platinum-resistant disease.
- For patients with platinum-resistant or refractory high-grade epithelial ovarian cancer and validated folate receptor-α expression, mirvetuximab soravtansine-gynx, an antibody drug conjugate targeting folate receptor-α, is strongly recommended. Other systemic treatment options for this group include PLD monotherapy, paclitaxel weekly or once every 3 weeks, bevacizumab combined with chemotherapy, or relacorilant plus nab-paclitaxel.
The Expert Panel did not find enough evidence to recommend surgical interventions such as secondary cytoreduction or hyperthermic intraperitoneal chemotherapy, while they recommend offering posttreatment monitoring and specialty survivorship care on a case-by-case basis.
A Living Guideline With Continuous Updates
The recommendations in this Living Guideline will continue to evolve as new clinical trial data become available, said Dr. Lesnock. “We acknowledge the clinical trials landscape is evolving, and we hope to highlight eligibility for patients at all levels of recurrence and care, so that identification of active agents that improve survival and/or result in less toxicity for these patients can be updated in this guideline in real time,” she said.
Dr. Lesnock is optimistic that the newly drafted recommendations will also empower patients with ovarian cancer to become self-advocates for evidence-based care. “Having a rigorous evidence-based guideline can enable patients to talk with their providers about why a treatment may be recommended, or why another one may not be recommended, and to highlight the role of clinical trials and whether those are available in a region for that patient,” she concluded.
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 August 24, 2026.
2. Gaitskell K, Hermon C, Barnes I, et al: Million Women Study Collaborators. Ovarian cancer survival by stage, histotype, and pre-diagnostic lifestyle factors, in the prospective UK Million Women Study. Cancer Epidemiol 76:102074, 2022.
3. Alizadeh H, Akbarabadi P, Dadfar A, et al: A comprehensive overview of ovarian cancer stem cells: correlation with high recurrence rate, underlying mechanisms, and therapeutic opportunities. Mol Cancer 24(1):135, 2025.
Reprinted with permission from ASCO Daily News, August 24, 2026.
