ASCO Releases First Living Guideline for Recurrent Ovarian Cancer Care

An American Society of Clinical Oncology (ASCO) Expert Panel has approved the society’s first-ever Living Guideline on the systemic treatment of recurrent ovarian cancer. Led by co-chairs Jamie Lesnock, MD, of the University of Pittsburgh Medical Center and Jennifer Scalici, MD, of Emory University, this dynamic guideline establishes a standardized clinical framework for gynecologic and medical oncologists, oncology nurses, patients, and caregivers. The guideline addresses the management of recurrent epithelial ovarian cancer (EOC), primary peritoneal carcinoma, fallopian tube carcinoma, and high-grade serous or endometrioid-type ovarian cancers.

Approximately 75% of women present with advanced stage II to IV ovarian cancer at diagnosis. While many initially achieve clinical remission, 70% to 80% will eventually experience recurrence.

"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," noted Lesnock in an ASCO Daily News release. Scalici added that managing EOC 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. ... How and when to use them, however, is not always clear."

Key Recommendations for Platinum-Sensitive Disease

Developed from systematic reviews of randomized controlled trials (RCTs) from 2004 through 2025, the guideline recommends three platinum-based doublets for recurrent platinum-sensitive EOC:

• PLD plus Carboplatin: Pegylated liposomal doxorubicin plus carboplatin is recommended (Evidence quality: Low; Strength: Strong).
• Paclitaxel plus Carboplatin: This standard combination remains a cornerstone of therapy (Evidence quality: Moderate; Strength: Strong).
• Gemcitabine plus Carboplatin: Recommended as an alternative option (Evidence quality: Moderate; Strength: Conditional).

Additionally, bevacizumab may be added to any of these platinum-based doublets, followed by bevacizumab maintenance therapy (Evidence quality: Moderate; Strength: Strong). Conversely, the panel strongly recommends that clinicians do not offer trabectedin in addition to PLD due to a lack of added clinical benefit (Evidence quality: Moderate; Strength: Strong).

The role of PARP inhibitors (PARPi) in recurrent EOC has evolved due to emerging overall survival data and safety concerns. Highly selective PARPi use is advised, with a dedicated guideline update currently pending.

Key Recommendations for Platinum-Resistant Disease

For patients with platinum-resistant or refractory high-grade EOC, the guideline places a strong emphasis on biomarker-driven therapy:

• Mirvetuximab Soravtansine: Strongly recommended for patients with validated folate receptor-alpha (FRα) expression (defined as ≥75% of tumor cells with ≥2+ staining intensity via immunohistochemistry [IHC]) (Evidence quality: High; Strength: Strong).
• Other Chemotherapies: Alternative regimens include PLD monotherapy (Evidence quality: High; Strength: Strong), weekly or tri-weekly paclitaxel (Evidence quality: Moderate; Strength: Strong), bevacizumab combined with chemotherapy (Evidence quality: Moderate; Strength: Strong), or relacorilant plus nab-paclitaxel (Evidence quality: Moderate; Strength: Conditional).

Notably, the panel concluded there is currently insufficient evidence to recommend surgical interventions, such as secondary cytoreduction or hyperthermic intraperitoneal chemotherapy (HIPEC), for patients with recurrent platinum-resistant disease. However, for platinum-sensitive recurrences, secondary cytoreduction may be discussed if there is significant evidence that complete gross resection is obtainable, particularly for patients with longer disease-free intervals and focal recurrences.

Key Takeaways for Oncology Nurses

Oncology nurses are at the forefront of administering these complex regimens, managing toxicities, and supporting patient survivorship. The Living Guideline underscores several critical areas for nursing practice:

• Prioritize Biomarker Screening: Ensure patients with platinum-resistant recurrence undergo IHC testing for FRα expression. Verifying ≥75% of tumor cells have ≥2+ staining intensity is mandatory before initiating mirvetuximab soravtansine.
• Understand the Nebulous Nature of Resistance: Be aware that the widespread use of frontline PARPi maintenance has altered tumor biology. The traditional boundary between platinum-sensitive and platinum-resistant disease is increasingly nebulous, requiring careful monitoring of the patient's individual recurrence timeline.
• Evaluate Patient Treatment History: Review prior therapeutic exposures when managing recurrences. Prior toxicities and drug exposures heavily dictate the safety and tolerability of subsequent systemic choices, regardless of trial data.
• Inquire About Clinical Trials: Empower patients to become self-advocates. Nurses should educate patients on local clinical trials, including trials investigating next-generation antibody-drug conjugates (ADCs) with novel targets and topoisomerase I payloads, such as the active DESTINY-Ovarian01 trial (NCT06819007).
• Incorporate Survivorship Planning: Collaborate with patients to discuss goals of care, comorbidities, treatment burden, financial or insurance considerations, and caregiver concerns. Survivorship care and monitoring should be offered on a case-by-case basis.

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. doi:10.1200/JCO-26-01591
2. Zegarac JP. ASCO Issues Its First Living Guideline on Systemic Treatment of Recurrent Ovarian Cancer. ASCO Daily News. Published August 24, 2026.