Ovarian cancer: lines of therapy
15 standard-of-care settings across 7 lines and 5 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | BRCA / HRD | FRα | HR-positive | PD-L1 |
|---|---|---|---|---|---|
| Screening, prevention and diagnosis | 1 | · | · | · | · |
| Early / localised | 1 | · | · | · | · |
| Locally advanced | 1 | · | · | · | · |
| Advanced, first line | 1 | · | · | · | · |
| Maintenance | · | 3 | · | · | · |
| Second line | 4 | · | 1 | · | 1 |
| Other settings | 1 | · | · | 1 | · |
Screening, prevention and diagnosis
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Prevention and risk | 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). | NCCN · Genetic/Familial High-Risk Assessment v2.20… | 91 |
Early / localised
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Newly diagnosed stage I-II | Complete surgical staging; adjuvant carboplatin-paclitaxel for high-grade or stage IC-II disease; observation for low-risk stage IA-IB grade 1-2. | NCCN · 1 | 81 |
Locally advanced
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Newly diagnosed stage III-IV: surgery and chemotherapy | 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. | NCCN · 1 (chemotherapy); 2A (HIPEC) | 98 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Newly diagnosed | Surgery + platinum-taxane ± bevacizumab ± HIPEC; PARP maintenance by HRD status. | NCCN Guidelines: Ovarian Cancer | 87 |
Maintenance
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| BRCA / HRD | First-line maintenance, BRCA-mutated | Olaparib 2 years (SOLO-1) or olaparib + bevacizumab (PAOLA-1) or niraparib 3 years (PRIMA). | NCCN · 1ESMO-MCBS · A | 87 | |
| BRCA / HRD | First-line maintenance, HRD-positive BRCA-wild-type | Olaparib + bevacizumab (PAOLA-1, OS benefit) or niraparib (PRIMA, PFS only). | NCCN · 1 | 98 | |
| BRCA / HRD | First-line maintenance, HRD-negative | Bevacizumab continuation if started; niraparib is an option with small PFS benefit and no OS benefit (PRIMA); observation is reasonable. | NCCN · 2A | 98 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Platinum-sensitive relapse | Platinum doublet + PARP maintenance; secondary cytoreduction in selected cases. | NCCN Guidelines: Ovarian Cancer | — | |
| All comers | Platinum-resistant | Mirvetuximab (FRα-high), relacorilant + nab-paclitaxel, pembrolizumab (PD-L1+), single-agent chemotherapy. | ESMO-MCBS · 2 (SORAYA mirvetuximab, single-arm) | 98 | |
| All comers | Platinum-sensitive relapse (interval >6 months) | 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. | NCCN · 1 (surgery in selected); 2A | 98 | |
| All comers | Platinum-resistant relapse, other | Relacorilant + nab-paclitaxel (ROSELLA, approved 2026); single-agent weekly paclitaxel, PLD, or topotecan ± bevacizumab (AURELIA); clinical trials of FRα and CDH6 ADCs. | NCCN · 2A | 98 | |
| FRα | Platinum-resistant relapse, FRα-high | Mirvetuximab soravtansine (MIRASOL, OS benefit) with ophthalmic prophylaxis. | NCCN · 1ESMO-MCBS · 4 | 77 | |
| PD-L1 | Platinum-resistant relapse, PD-L1 CPS ≥1 | Pembrolizumab + weekly paclitaxel ± bevacizumab (KEYNOTE-B96, approved Feb 2026). | NCCN · 1 (2026 update) | 98 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Rare histologies | 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. | 99 | ||
| HR-positive | Low-grade serous carcinoma | Surgery; endocrine maintenance (letrozole) after chemotherapy or instead of it; at recurrence, avutometinib + defactinib if KRAS-mutated (2025), trametinib, or endocrine therapy. | NCCN · 2A | 89 |
Sequence and caution pairings
Regimens in the library
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.