Platinum-resistant ovarian cancer: the decisions you may face
5 treatment settings, 4 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Folate receptor alpha-high
Mirvetuximab soravtansine with ophthalmic monitoring (MIRASOL).
Mirvetuximab soravtansine (Elahere) is the first ADC for ovarian cancer, for tumours with high folate receptor alpha.
An antibody-drug conjugate is an antibody that homes to a protein on the tumour cell, is swallowed, and releases a chemotherapy payload inside it. That widens chemotherapy's safe dose window about a hundredfold, which is why payloads too toxic to give alone can be used, though lung inflammation, neutropenia and eye toxicity from the payload still occur.
- Widens the therapeutic index of chemotherapy 100-fold
- Works in 'low' antigen expressers via bystander effect
- Active after chemotherapy resistance
- Platinum-resistant ovarian cancer with high folate receptor alpha expression, 1-3 prior lines: mirvetuximab soravtansine vs chemotherapy
OS 16.46 vs 12.75 months (HR 0.67).
Progression-free survival (months): Mirvetuximab 5.62 (n=227) vs Chemotherapy 3.98 (n=226) · HR 0.65 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| AST increased · MIRASOL; all-grade rates | 57% | - |
| Fatigue · MIRASOL; all-grade rates | 47% | - |
| Blurred vision · MIRASOL; all-grade rates | 45% | - |
| ALT increased · MIRASOL; all-grade rates | 38% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Payload-class toxicities are systemic (neutropenia, ILD, neuropathy, ocular)
- Resistance via antigen loss, efflux, TOP1/SLFN11 changes
- Manufacturing cost
- Between Mirvetuximab soravtansine and Antibody-drug conjugate (ADC), which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in MIRASOL / GOG-3045, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Mirvetuximab soravtansine are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (folate receptor alpha-high), which of the standard options do you recommend and why?Why: Guideline options include: Mirvetuximab soravtansine with ophthalmic monitoring (MIRASOL).
- Am I a candidate for Mirvetuximab soravtansine, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of MIRASOL / GOG-3045 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
PD-L1 CPS 1 or more
Pembrolizumab with weekly paclitaxel, with bevacizumab where not previously given (KEYNOTE-B96).
Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.
A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.
Bevacizumab is a humanised antibody that soaks up VEGF-A, the signal tumours use to grow new blood vessels. Approved in 2004, it partners chemotherapy in colorectal, ovarian, cervical, lung, kidney and liver cancer and glioblastoma, and adds to trifluridine/tipiracil in late-line bowel cancer; hypertension, protein in the urine and bleeding are its characteristic side effects.
- Platinum-resistant recurrent ovarian cancer, 1-2 prior lines: pembrolizumab + weekly paclitaxel ± bevacizumab vs placebo + paclitaxel ± bevacizumab
OS 18.2 vs 14.0 months in CPS ≥1 (HR 0.76); ITT OS HR 0.82.
Progression-free survival (CPS ≥1) (months): Pembrolizumab + paclitaxel ± bev 8.3 vs Placebo + paclitaxel ± bev 7.2 · HR 0.72 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients | 8% | - |
| Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 3.4% | - |
| Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 1.7% | - |
| Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 0.7% | - |
- No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Between Pembrolizumab, Paclitaxel / nab-paclitaxel and Bevacizumab, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in KEYNOTE-B96 / ENGOT-ov65, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Pembrolizumab are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (pd-l1 cps 1 or more), which of the standard options do you recommend and why?Why: Guideline options include: Pembrolizumab with weekly paclitaxel, with bevacizumab where not previously given (KEYNOTE-B96).
- Am I a candidate for Pembrolizumab, Paclitaxel / nab-paclitaxel, Bevacizumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-B96 / ENGOT-ov65 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Any expression status
Relacorilant with nab-paclitaxel (ROSELLA); or single-agent weekly paclitaxel, pegylated liposomal doxorubicin, topotecan or gemcitabine with bevacizumab if bevacizumab-naive (AURELIA).
A first-in-class drug that blocks cortisol signalling in tumour cells, approved in 2026 for platinum-resistant ovarian cancer with chemotherapy.
A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.
Doxorubicin wrapped in a fatty bubble so it reaches tumours with less heart damage; a workhorse of relapsed ovarian cancer.
Topotecan is the long-standing second-line chemotherapy for relapsed small-cell lung cancer, and now the comparator that new drugs must beat.
A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.
Bevacizumab is a humanised antibody that soaks up VEGF-A, the signal tumours use to grow new blood vessels. Approved in 2004, it partners chemotherapy in colorectal, ovarian, cervical, lung, kidney and liver cancer and glioblastoma, and adds to trifluridine/tipiracil in late-line bowel cancer; hypertension, protein in the urine and bleeding are its characteristic side effects.
- Platinum-resistant ovarian cancer, 1-3 prior lines: relacorilant + nab-paclitaxel vs nab-paclitaxel
OS 16.0 vs 11.9 months (HR 0.69).
Progression-free survival (months): Relacorilant + nab-paclitaxel 6.5 (n=188) vs Nab-paclitaxel 5.5 (n=193) · HR 0.7 · source
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
- Between Relacorilant, Paclitaxel / nab-paclitaxel, Pegylated liposomal doxorubicin and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in ROSELLA / GOG-3073, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (any expression status), which of the standard options do you recommend and why?Why: Guideline options include: Relacorilant with nab-paclitaxel (ROSELLA); or single-agent weekly paclitaxel, pegylated liposomal doxorubicin, topotecan or gemcitabine with bevacizumab if bevacizumab-naive (AURELIA).
- Am I a candidate for Relacorilant, Paclitaxel / nab-paclitaxel, Pegylated liposomal doxorubicin or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ROSELLA / GOG-3073 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Later lines
Clinical trials of antibody-drug conjugates against CDH6, folate receptor alpha, B7-H4 and TROP2; hormonal therapy in receptor-positive low-grade disease.
Raludotatug deruxtecan is a CDH6 ADC in phase 3 for platinum-resistant ovarian cancer.
Rinatabart sesutecan is a next-generation folate-receptor ADC with a topoisomerase payload that responds in both ovarian and endometrial cancer regardless of receptor level.
A folate-receptor ADC designed to work across low and high receptor levels, in a pivotal ovarian cancer trial.
Daily pills that stop the body making oestrogen after menopause, the backbone of hormone therapy for most breast cancers.
- Tests Raludotatug deruxtecanPlatinum-resistant ovarian cancer, 1-3 prior lines: raludotatug deruxtecan (CDH6 ADC) vs physician's-choice chemotherapy
Phase 2 ORR 50.5%; phase 3 ongoing.
- Tests Rinatabart sesutecanAdvanced ovarian and endometrial cancer, heavily pretreated: rinatabart sesutecan (FRα ADC, exatecan payload) across FRα expression levels
ORR 55.6% (ovarian, 120 mg/m²); 50% (endometrial, 100 mg/m²).
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
- Between Raludotatug deruxtecan, Rinatabart sesutecan, Luveltamab tazevibulin and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in REJOICE-Ovarian01 and RAINFOL-01 (Rina-S), and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (later lines), which of the standard options do you recommend and why?Why: Guideline options include: Clinical trials of antibody-drug conjugates against CDH6, folate receptor alpha, B7-H4 and TROP2; hormonal therapy in receptor-positive low-grade disease.
- Am I a candidate for Raludotatug deruxtecan, Rinatabart sesutecan, Luveltamab tazevibulin or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of REJOICE-Ovarian01 and RAINFOL-01 (Rina-S) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Supportive care
Early palliative care, drainage of ascites, management of bowel obstruction and nutritional support alongside anticancer treatment.
This setting names no product or technology record yet; the approach above is the standard as written. Ask your team which specific treatments they mean.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
- Which specific treatments are you proposing for this setting, and what are the alternatives?Why: The standard of care here is described in words rather than named products; ask for the names.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (supportive care), which of the standard options do you recommend and why?Why: Guideline options include: Early palliative care, drainage of ascites, management of bowel obstruction and nutritional support alongside anticancer treatment.
Add these to your appointment list, or take the full question set for this cancer.