Ovarian cancer: guideline history

Anchored to: FDA approvals of first-line maintenance olaparib (December 2018, SOLO-1), niraparib (April 2020, PRIMA) and olaparib with bevacizumab (May 2020, PAOLA-1)

• addedNewly diagnosed, maintenance after platinum response: PARP inhibitor maintenance: olaparib for BRCA-mutated disease, niraparib regardless of biomarker, olaparib plus bevacizumab for HRD-positive disease.

Anchored to: Sponsor withdrawals of later-line PARP inhibitor treatment indications (June to September 2022) after overall-survival signals; FDA accelerated approval of mirvetuximab soravtansine (November 2022)

• removedRecurrent, later-line treatment (not maintenance): Olaparib, rucaparib and niraparib as treatment (rather than maintenance) in heavily pretreated disease removed after the US indications were withdrawn; niraparib recurrent maintenance restricted to BRCA-mutated disease.
• addedPlatinum-resistant, folate receptor alpha-high: Mirvetuximab soravtansine after 1-3 prior lines.

Anchored to: Annals of Oncology publication, 2023

• addedNewly diagnosed, maintenance: PARP inhibitor maintenance recommended for all patients responding to platinum, with the agent chosen by BRCA and HRD status [I, A].
• recategorisedRecurrent, platinum-sensitive: Secondary cytoreductive surgery recommended for selected patients (DESKTOP III) where previously not routinely advised.not routinely recommended → recommended for AGO-score-positive patients [I, A]