The first 60 days: Ovarian cancer
Usually found late. PARP inhibitors transformed maintenance therapy, and ADCs against folate receptor and CDH6 are arriving for platinum-resistant disease. Below, week by week, is what OnCo's record of Ovarian cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
Weeks 1 to 2
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Surgery + platinum-taxane ± bevacizumab ± HIPEC; PARP maintenance by HRD status.
- Newly diagnosed stage I-IINCCN category 1
Complete surgical staging; adjuvant carboplatin-paclitaxel for high-grade or stage IC-II disease; observation for low-risk stage IA-IB grade 1-2.
- Newly diagnosed stage III-IV: surgery and chemotherapyNCCN category 1 (chemotherapy); 2A (HIPEC)
Primary debulking if complete resection is feasible, else 3 cycles neoadjuvant carboplatin-paclitaxel then interval debulking (with HIPEC in stage III, OVHIPEC-1) and 3 more cycles; add bevacizumab for high-risk or residual disease.
Biomarkers your report may list
BRCA1/2 (germline and somatic)HRD (myChoice)FRα IHCCDH6CA-125PD-L1Germline and somatic BRCA1/2HRD genomic instability score (myChoice CDx, FoundationOne)Folate receptor alpha IHC (≥75% of cells at 2+ for mirvetuximab)PD-L1 CPS ≥1 (pembrolizumab, KEYNOTE-B96)KRAS/BRAF/NRAS (low-grade serous)CA-125 and HE4 (monitoring, ROMA index)Platinum-free interval (defines sensitive vs resistant)MMR/MSI (endometrioid, clear-cell)HER2 (mucinous, some clear-cell)
Ask which of these were tested and what the results were; see the report reader for what each value means.
Tests and imaging linked to this cancer
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Prevention and risk, First-line maintenance, HRD-positive BRCA-wild-type.
- SurgeonNamed in the standard of care for: Newly diagnosed, Prevention and risk, Newly diagnosed stage I-II, Newly diagnosed stage III-IV: surgery and chemotherapy and 1 more.
- Medical oncologistNamed in the standard of care for: Newly diagnosed, Platinum-resistant, Newly diagnosed stage I-II, Newly diagnosed stage III-IV: surgery and chemotherapy and 9 more.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Germline testing for all patients; risk-reducing salpingo-oophorectomy for BRCA carriers (age 35-45); opportunistic salpingectomy at pelvic surgery for average-risk women; oral contraceptives reduce risk. No population screening (UKCTOCS negative).
Surgery; endocrine maintenance (letrozole) after chemotherapy or instead of it; at recurrence, avutometinib + defactinib if KRAS-mutated (2025), trametinib, or endocrine therapy.
Clear-cell: platinum-based therapy, trials of immunotherapy and ARID1A-directed agents; mucinous: consider GI regimens and HER2 testing; germ-cell: BEP chemotherapy with >90% cure.
Platinum doublet + PARP maintenance; secondary cytoreduction in selected cases.
Mirvetuximab (FRα-high), relacorilant + nab-paclitaxel, pembrolizumab (PD-L1+), single-agent chemotherapy.
Secondary cytoreduction if AGO-score positive (DESKTOP III); platinum doublet (carboplatin with PLD, paclitaxel, or gemcitabine) ± bevacizumab; PARP maintenance if PARP-naive and BRCA/HRD-positive.
Mirvetuximab soravtansine (MIRASOL, OS benefit) with ophthalmic prophylaxis.
Pembrolizumab + weekly paclitaxel ± bevacizumab (KEYNOTE-B96, approved Feb 2026).
Relacorilant + nab-paclitaxel (ROSELLA, approved 2026); single-agent weekly paclitaxel, PLD, or topotecan ± bevacizumab (AURELIA); clinical trials of FRα and CDH6 ADCs.
Olaparib 2 years (SOLO-1) or olaparib + bevacizumab (PAOLA-1) or niraparib 3 years (PRIMA).
Olaparib + bevacizumab (PAOLA-1, OS benefit) or niraparib (PRIMA, PFS only).
Bevacizumab continuation if started; niraparib is an option with small PFS benefit and no OS benefit (PRIMA); observation is reasonable.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example BRCA1/2, HRD, FRα IHC, CDH6, CA-125), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include High-grade serous carcinoma, Low-grade serous carcinoma, Endometrioid carcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
- For my situation (newly diagnosed), which of the standard options do you recommend and why?Guideline options include: Surgery + platinum-taxane ± bevacizumab ± HIPEC; PARP maintenance by HRD status.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Olaparib or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Platinum-sensitive relapse
- For my situation (platinum-sensitive relapse), which of the standard options do you recommend and why?Guideline options include: Platinum doublet + PARP maintenance; secondary cytoreduction in selected cases.
Platinum-resistant
- For my situation (platinum-resistant), which of the standard options do you recommend and why?Guideline options include: Mirvetuximab (FRα-high), relacorilant + nab-paclitaxel, pembrolizumab (PD-L1+), single-agent chemotherapy.
- Am I a candidate for Mirvetuximab soravtansine, Relacorilant, Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Prevention and risk
- For my situation (prevention and risk), which of the standard options do you recommend and why?Guideline options include: Germline testing for all patients; risk-reducing salpingo-oophorectomy for BRCA carriers (age 35-45); opportunistic salpingectomy at pelvic surgery for average-risk women; oral contraceptives reduce risk. No population screening (UKCTOCS negative).
- How do the results of UKCTOCS apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Newly diagnosed stage I-II
- For my situation (newly diagnosed stage i-ii), which of the standard options do you recommend and why?Guideline options include: Complete surgical staging; adjuvant carboplatin-paclitaxel for high-grade or stage IC-II disease; observation for low-risk stage IA-IB grade 1-2.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Newly diagnosed stage III-IV: surgery and chemotherapy
- For my situation (newly diagnosed stage iii-iv: surgery and chemotherapy), which of the standard options do you recommend and why?Guideline options include: Primary debulking if complete resection is feasible, else 3 cycles neoadjuvant carboplatin-paclitaxel then interval debulking (with HIPEC in stage III, OVHIPEC-1) and 3 more cycles; add bevacizumab for high-risk or residual disease.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Bevacizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of OVHIPEC-1 and GOG-0218 & ICON7 (bevacizumab) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
First-line maintenance, BRCA-mutated
- For my situation (first-line maintenance, brca-mutated), which of the standard options do you recommend and why?Guideline options include: Olaparib 2 years (SOLO-1) or olaparib + bevacizumab (PAOLA-1) or niraparib 3 years (PRIMA).
- Am I a candidate for Olaparib, Niraparib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of SOLO-1 and PAOLA-1 / ENGOT-ov25 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
First-line maintenance, HRD-positive BRCA-wild-type
- For my situation (first-line maintenance, hrd-positive brca-wild-type), which of the standard options do you recommend and why?Guideline options include: Olaparib + bevacizumab (PAOLA-1, OS benefit) or niraparib (PRIMA, PFS only).
- Am I a candidate for Olaparib, Bevacizumab, Niraparib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PAOLA-1 / ENGOT-ov25 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
First-line maintenance, HRD-negative
- For my situation (first-line maintenance, hrd-negative), which of the standard options do you recommend and why?Guideline options include: Bevacizumab continuation if started; niraparib is an option with small PFS benefit and no OS benefit (PRIMA); observation is reasonable.
- Am I a candidate for Bevacizumab, Niraparib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PRIMA / ENGOT-OV26 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Platinum-sensitive relapse (interval >6 months)
- For my situation (platinum-sensitive relapse (interval >6 months)), which of the standard options do you recommend and why?Guideline options include: Secondary cytoreduction if AGO-score positive (DESKTOP III); platinum doublet (carboplatin with PLD, paclitaxel, or gemcitabine) ± bevacizumab; PARP maintenance if PARP-naive and BRCA/HRD-positive.
- Am I a candidate for Carboplatin, Pegylated liposomal doxorubicin, Bevacizumab or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of DESKTOP III / ENGOT-ov20 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Platinum-resistant relapse, FRα-high
- For my situation (platinum-resistant relapse, frα-high), which of the standard options do you recommend and why?Guideline options include: Mirvetuximab soravtansine (MIRASOL, OS benefit) with ophthalmic prophylaxis.
- Am I a candidate for Mirvetuximab soravtansine, and what side effects should I expect?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?Trial populations differ from individual patients; ask how closely you match.
Platinum-resistant relapse, PD-L1 CPS ≥1
- For my situation (platinum-resistant relapse, pd-l1 cps ≥1), which of the standard options do you recommend and why?Guideline options include: Pembrolizumab + weekly paclitaxel ± bevacizumab (KEYNOTE-B96, approved Feb 2026).
- Am I a candidate for Pembrolizumab, Paclitaxel / nab-paclitaxel, Bevacizumab, and what side effects should I expect?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?Trial populations differ from individual patients; ask how closely you match.
Platinum-resistant relapse, other
- For my situation (platinum-resistant relapse, other), which of the standard options do you recommend and why?Guideline options include: Relacorilant + nab-paclitaxel (ROSELLA, approved 2026); single-agent weekly paclitaxel, PLD, or topotecan ± bevacizumab (AURELIA); clinical trials of FRα and CDH6 ADCs.
- Am I a candidate for Relacorilant, Pegylated liposomal doxorubicin, Bevacizumab or related drugs, and what side effects should I expect?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?Trial populations differ from individual patients; ask how closely you match.
Low-grade serous carcinoma
- For my situation (low-grade serous carcinoma), which of the standard options do you recommend and why?Guideline options include: Surgery; endocrine maintenance (letrozole) after chemotherapy or instead of it; at recurrence, avutometinib + defactinib if KRAS-mutated (2025), trametinib, or endocrine therapy.
- Am I a candidate for Letrozole (and other aromatase inhibitors), Avutometinib + defactinib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of RAMP 201 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Rare histologies
- For my situation (rare histologies), which of the standard options do you recommend and why?Guideline options include: Clear-cell: platinum-based therapy, trials of immunotherapy and ARID1A-directed agents; mucinous: consider GI regimens and HER2 testing; germ-cell: BEP chemotherapy with >90% cure.
Any stage
- Are there clinical trials I could join, for example of Raludotatug deruxtecan, Puxitatug samrotecan, PARP PET, Galleri?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “No effective screening”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “PARP resistance via BRCA reversion”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- A Clinical Trial of Sac-TMT in People With Non-HRD Positive Advanced Ovarian Cancer (MK-2870-021)Phase 3 · recruiting · NCT07318558A Phase 3, Randomized, Open-label, Multicenter Study of Sacituzumab Tirumotecan (Sac-TMT, MK-2870) Maintenance Treatment With or Without Bevacizumab Versus Standard of Care in Participants With Newly Diagnosed Advanced Non-HRD Positive Ovarian Cancer Following First-line Platinum-based Chemotherapy (TroFuse-021/ENGOTov85/GOG-3102)
- A Comparison of Platinum-based Therapy With TSR-042 and Niraparib Versus Standard of Care (SOC) Platinum-based Therapy as First-line Treatment of Stage III or IV Nonmucinous Epithelial Ovarian CancerPhase 3 · active · NCT03602859A Randomized, Double-blind, Phase 3 Comparison of Platinum-based Therapy With TSR-042 and Niraparib Versus Standard of Care Platinum-based Therapy as First-line Treatment of Stage III or IV Nonmucinous Epithelial Ovarian Cancer
- A Study Comparing BL-B01D1 With the Investigator's Choice of Chemotherapy in Patients With Platinum-resistant Recurrent Epithelial Ovarian Cancer(PANKPhase 3 · recruiting · NCT06994195A Phase III Randomized Controlled Clinical Study Comparing BL-B01D1 With the Investigator's Choice of Chemotherapy in Patients With Platinum-resistant Recurrent Epithelial Ovarian Cancer
- A Study of Avutometinib (VS-6766) + Defactinib (VS-6063) in Recurrent Low-Grade Serous Ovarian CancerPhase 3 · recruiting · NCT06072781A Phase 3, Randomized, Open-Label Study of Combination Therapy With Avutometinib Plus Defactinib Versus Investigator's Choice of Treatment in Patients With Recurrent Low-Grade Serous Ovarian Cancer (LGSOC) (RAMP 301)
- A Study of Azenosertib (ZN-c3) Versus Investigator's Choice Chemotherapy in Subjects With Platinum-Resistant High-Grade Serous Ovarian, Primary Peritoneal, or Fallopian Tube Cancers Positive for Cyclin E1 Protein ExpressionPhase 3 · recruiting · NCT07546500A Randomized, Open-Label Phase 3 Study of Azenosertib Versus Investigator's Choice of Chemotherapy in Platinum-Resistant High-Grade Serous Ovarian, Primary Peritoneal, or Fallopian Tube Cancers Positive for Cyclin E1 Protein Expression
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Ovarian cancer: the full pageUsually found late. PARP inhibitors transformed maintenance therapy, and ADCs against folate receptor and CDH6 are arriving for platinum-resistant disease.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Guidelines comparedNCCN, ESMO and NICE side by side for this cancer.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
Words this page and the cancer page use
- Low-grade serous ovarian cancer (LGSOC): Low-grade serous ovarian cancer is a slow-growing, RAS-driven type of ovarian cancer that resists chemotherapy but responds to hormone blockers and MEK-pathway drugs.
- High-grade serous ovarian carcinoma (HGSOC): High-grade serous ovarian carcinoma is the most common type of ovarian cancer and the one most often found late; it actually starts in the fallopian tube and almost always has a broken TP53 gene, and it is the type PARP inhibitors were built for.
- CA-125: A blood protein that rises in most ovarian cancers; useful for tracking treatment, useless for screening on its own.
- Synthetic lethality: Two genes where losing either alone is fine but losing both kills the cell.
- Debulking (cytoreductive surgery): Surgery that removes as much tumour as possible when it cannot all be removed cleanly; leaving nothing visible behind is what matters.
- Intraperitoneal (IP) chemotherapy: Delivering chemotherapy directly into the abdominal cavity through a catheter, so the tumour deposits on the lining get a far higher dose than the rest of the body would tolerate.
- Salpingo-oophorectomy: Removing the ovaries and fallopian tubes.
- Platinum-sensitive / platinum-resistant: Whether a cancer that responded to platinum chemotherapy came back more than six months later (sensitive, so platinum can be used again) or sooner (resistant, so something else is needed).
- HIPEC (hyperthermic intraperitoneal chemotherapy): After surgeons remove all visible tumour from the abdominal lining, the abdomen is bathed for 60-90 minutes in heated chemotherapy to kill the microscopic cells left behind.
- Maintenance therapy: Ongoing, gentler treatment given after the main course has shrunk the cancer, to hold it in check for as long as possible rather than to shrink it further.
Every term links to the glossary.