# Platinum-sensitive ovarian cancer

Source: https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/  
OnCo record `platinum-sensitive-ovarian-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Platinum-sensitive ovarian cancer is disease that responded to carboplatin and either has not relapsed or relapses more than six months after the last dose. It is treated with further platinum chemotherapy, sometimes repeat surgery, and above all with maintenance PARP inhibitors, which keep BRCA-mutant tumours away for years and have raised long-term survival.

## Summary

Platinum sensitivity is a clinical state rather than a histology. A tumour that shrinks on carboplatin-paclitaxel and stays away for more than six months after the last cycle is likely to respond to platinum again, and the longer the platinum-free interval the better the response; most high-grade serous and endometrioid cancers begin in this state and drift towards resistance with each relapse. Biologically, sensitivity tracks homologous recombination deficiency: BRCA1 or BRCA2 mutation, found in about a fifth of high-grade serous tumours, and other defects that together mark about half, cannot repair the DNA crosslinks platinum causes, and the same defect makes them vulnerable to PARP inhibition. Germline and somatic BRCA testing and HRD testing are therefore standard at diagnosis.

Maintenance after first-line chemotherapy is the setting with the clearest gains. SOLO-1 gave two years of olaparib to women with BRCA-mutant tumours in response to platinum and cut the hazard of progression to 0.30; at seven years 67.0 percent were alive against 46.5 percent with placebo, a hazard ratio for death of 0.55 and the first sign that maintenance changes survival rather than delaying relapse. PRIMA extended niraparib to all comers with a progression-free survival gain from 8.2 to 13.8 months overall and from 10.4 to 21.9 months in HRD-positive tumours, though its final overall survival analysis showed no difference. PAOLA-1 added olaparib to bevacizumab maintenance and, in HRD-positive tumours, extended progression-free survival from 17.7 to 37.2 months with five-year survival of 65.5 percent against 48.4 percent. ATHENA-MONO confirmed the class with rucaparib. Which drug, whether to add bevacizumab, and whether HRD-negative tumours gain enough to justify treatment are decided by the tests.

At platinum-sensitive relapse, DESKTOP III showed that secondary cytoreductive surgery in women selected by a positive AGO score, complete resection at first surgery, good performance status and no ascites, extended median survival from 46.0 to 53.7 months when complete resection was achieved. Chemotherapy is a platinum doublet, carboplatin with pegylated liposomal doxorubicin, gemcitabine or paclitaxel, with bevacizumab in patients who have not had it, followed by PARP inhibitor maintenance if none was given before. Trials in relapse showed that PARP inhibitor maintenance after a later-line response delayed progression but did not improve survival in non-BRCA tumours and regulators narrowed those labels in 2022 and 2023, so the main benefit is now taken in the first line. Second PARP inhibitor exposure after progression, HRD-restoring reversion mutations and circulating tumour DNA to guide the duration of maintenance are the current research questions.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Platinum-sensitive relapsed ovarian cancer; Newly diagnosed ovarian cancer in response to platinum; Platinum-free interval over six months
- Tags: subtype-page
- Group: gynaecologic
- Burden: Most advanced ovarian cancers respond to first-line platinum, and the majority of relapses occur more than six months after the last platinum dose; this state covers the largest group of women on treatment and is where PARP inhibitor maintenance has changed the natural history.
- Subtypes: Newly diagnosed advanced disease in response to first-line platinum (maintenance setting); BRCA1 or BRCA2-mutant, platinum-sensitive (olaparib, SOLO-1); HRD-positive, BRCA-wild-type (olaparib with bevacizumab, PAOLA-1; niraparib, PRIMA); HRD-negative or proficient (niraparib or bevacizumab maintenance, smaller gains); First platinum-sensitive relapse, AGO-score positive (secondary surgery, DESKTOP III); Platinum-sensitive relapse after prior PARP inhibitor; High-grade serous carcinoma (most cases)
- Biomarkers: Platinum-free interval (over six months defines sensitivity); Germline and somatic BRCA1 and BRCA2; HRD genomic instability score; CA-125 kinetics; AGO score for secondary surgery (complete first resection, performance status, ascites); BRCA reversion mutations at progression on PARP inhibitor

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/platinum-sensitive-ovarian-cancer/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/#overview [3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/#what-it-is [7 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/#finding-it [6 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/#treating-it [5 settings, 5 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/#evidence [21 trials, 4 key papers, 8 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/#science [5 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/#living-with-it [24 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/coming/ [9 medicines, 19 trials, 1 idea, 3 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/data/ [63 connected records]

## Standard of care

- First-line maintenance, BRCA-mutant: Olaparib for two years (SOLO-1), or olaparib with bevacizumab (PAOLA-1); niraparib as an alternative. ([Olaparib](https://onco.cc/drugs/olaparib/), [SOLO-1](https://onco.cc/trials/solo-1/), [PAOLA-1 / ENGOT-ov25](https://onco.cc/trials/paola-1/), [Niraparib](https://onco.cc/drugs/niraparib/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [PARP inhibitors](https://onco.cc/technologies/parp-inhibitor/))
- First-line maintenance, HRD-positive BRCA-wild-type: Olaparib plus bevacizumab (PAOLA-1) or niraparib (PRIMA) after HRD testing. ([Olaparib](https://onco.cc/drugs/olaparib/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [PAOLA-1 / ENGOT-ov25](https://onco.cc/trials/paola-1/), [Niraparib](https://onco.cc/drugs/niraparib/), [PRIMA / ENGOT-OV26](https://onco.cc/trials/prima/), [HRD & BRCA testing](https://onco.cc/technologies/hrd-testing/), [Homologous recombination deficiency (HRD)](https://onco.cc/terms/hrd/), [PARP inhibitor + bevacizumab maintenance (HRD-positive)](https://onco.cc/pairings/parp-plus-bevacizumab/))
- First-line maintenance, HRD-negative: Niraparib (PRIMA, smaller benefit) or bevacizumab; observation is reasonable after discussion. ([Niraparib](https://onco.cc/drugs/niraparib/), [PRIMA / ENGOT-OV26](https://onco.cc/trials/prima/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [GOG-0218 & ICON7 (bevacizumab)](https://onco.cc/trials/gog-0218-icon7/))
- First platinum-sensitive relapse: Secondary cytoreduction in AGO-score-positive patients (DESKTOP III), then carboplatin doublet with pegylated liposomal doxorubicin, gemcitabine or paclitaxel, bevacizumab if not previously given, and PARP inhibitor maintenance if PARP-naive. ([DESKTOP III / ENGOT-ov20](https://onco.cc/trials/desktop-iii/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Pegylated liposomal doxorubicin](https://onco.cc/drugs/pegylated-liposomal-doxorubicin/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Olaparib](https://onco.cc/drugs/olaparib/), [Niraparib](https://onco.cc/drugs/niraparib/), [Rucaparib](https://onco.cc/drugs/rucaparib/))
- Relapse after PARP inhibitor: Platinum doublet; PARP rechallenge has limited benefit; trials of ATR, WEE1 and next-generation PARP1-selective inhibitors. ([Carboplatin](https://onco.cc/drugs/carboplatin/), [Saruparib](https://onco.cc/drugs/saruparib/), [ATR](https://onco.cc/targets/atr/), [WEE1](https://onco.cc/targets/wee1/), [ATHENA-MONO / GOG-3020](https://onco.cc/trials/athena-mono/))

## State of the art

- SOLO-1's seven-year data showed PARP maintenance improves survival, not just time to relapse, in BRCA-mutant disease.
- HRD testing sorts patients into three maintenance strategies.
- DESKTOP III is the first randomised evidence that repeat surgery helps selected patients at relapse.

## Open problems

- Whether HRD-negative tumours gain enough from PARP inhibitors to justify two to three years of treatment.
- Resistance through BRCA reversion and restored homologous recombination.
- How long to continue maintenance, and whether circulating tumour DNA can tell.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Ovarian_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Ovarian_cancer

## Connected records

- cancers: [BRCA or PALB2-mutant pancreatic ductal adenocarcinoma](https://onco.cc/cancers/brca-palb2-pdac/), [High-grade serous ovarian cancer](https://onco.cc/cancers/high-grade-serous-ovarian-cancer/), [Low-grade serous ovarian cancer](https://onco.cc/cancers/low-grade-serous-ovarian-cancer/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Platinum-resistant ovarian cancer](https://onco.cc/cancers/platinum-resistant-ovarian-cancer/)
- terms: [BRCA reversion mutations](https://onco.cc/terms/brca-reversion-mutations/), [Homologous recombination deficiency (HRD)](https://onco.cc/terms/hrd/)
- key papers: [DESKTOP III: secondary cytoreductive surgery for recurrent platinum-sensitive ovarian cancer](https://onco.cc/key-papers/paper-desktop-iii-nejm-2021/), [PAOLA-1: olaparib added to bevacizumab maintenance in newly diagnosed ovarian cancer, with benefit confined to HRD-positive tumours](https://onco.cc/key-papers/paper-paola-1-nejm-2019/), [PRIMA: niraparib maintenance in newly diagnosed advanced ovarian cancer](https://onco.cc/key-papers/paper-prima-niraparib-nejm-2019/), [SOLO-1: two years of olaparib maintenance after first-line chemotherapy for BRCA-mutated ovarian cancer](https://onco.cc/key-papers/paper-solo-1-nejm-2018/)
- drugs: [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Niraparib](https://onco.cc/drugs/niraparib/), [Olaparib](https://onco.cc/drugs/olaparib/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pegylated liposomal doxorubicin](https://onco.cc/drugs/pegylated-liposomal-doxorubicin/), [Rucaparib](https://onco.cc/drugs/rucaparib/), [Saruparib](https://onco.cc/drugs/saruparib/)
- technologies: [HRD & BRCA testing](https://onco.cc/technologies/hrd-testing/), [PARP inhibitors](https://onco.cc/technologies/parp-inhibitor/)
- targets: [ATR](https://onco.cc/targets/atr/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [WEE1](https://onco.cc/targets/wee1/)
- trials: [A Clinical Study Evaluating a Combination of Oregovomab and Niraparib in Adult Women With Platinum Sensitive Recurrent Ovarian Cancer.](https://onco.cc/trials/nct05335993/), [A Clinical Study of SHR-A1811 Combined With Chemotherapy for Platinum Sensitive Recurrent Ovarian Cancer](https://onco.cc/trials/nct06840002/), [A Clinical Trial to Evaluate the Safety and Efficacy of COM701 in Relapsed Platinum Sensitive Ovarian Cancer](https://onco.cc/trials/nct06888921/), [A Study to Evaluate the Efficacy and Safety of Sacituzumab Tirumotecan (MK-2870) Maintenance Treatment Versus Standard of Care in Participants With Pl](https://onco.cc/trials/nct06824467/), [An RCT of Concurrent and Maintenance Cediranib in Women With Platinum-sensitive Relapsed Ovarian Cancer](https://onco.cc/trials/nct00532194/), [ATHENA-MONO / GOG-3020](https://onco.cc/trials/athena-mono/), [Combination Therapy of AK112 With Chemotherapy and/or Olaparib in Platinum-sensitive Ovarian Cancer](https://onco.cc/trials/nct06686030/), [DESKTOP III / ENGOT-ov20](https://onco.cc/trials/desktop-iii/), [DUO-O / ENGOT-ov46](https://onco.cc/trials/duo-o/), [GOG-0218 & ICON7 (bevacizumab)](https://onco.cc/trials/gog-0218-icon7/), [Maintenance Treatment With BGB-290 Versus Placebo in Participants With Platinum-sensitive Recurrent Ovarian Cancer](https://onco.cc/trials/nct03519230/), [Mirvetuximab Soravtansine (MIRV) With Carboplatin in Second-line Treatment of Folate Receptor Alpha (FRα) Expressing, Platinum-sensitive Epithelial Ov](https://onco.cc/trials/nct05456685/), [Mirvetuximab Soravtansine With Bevacizumab Versus Bevacizumab as Maintenance in Platinum-sensitive Epithelial Ovarian, Fallopian Tube, or Peritoneal C](https://onco.cc/trials/nct05445778/), [Olaparib Treatment in BRCA Mutated Ovarian Cancer Patients After Complete or Partial Response to Platinum Chemotherapy](https://onco.cc/trials/nct01874353/), [Oregovomab in Combination With Bevacizumab Plus Chemo in BRCA Wild Type Platinum Sensitive Recurrent Ovarian Cancer](https://onco.cc/trials/nct04938583/), [PAOLA-1 / ENGOT-ov25](https://onco.cc/trials/paola-1/), [PRIMA / ENGOT-OV26](https://onco.cc/trials/prima/), [SOLO-1](https://onco.cc/trials/solo-1/), [Study to Assess the Efficacy and Safety of Rina-S Plus Standard of Care Compared to Standard of Care for Maintenance Treatment of Participants With Re](https://onco.cc/trials/nct07225270/), [Study to Assess the Efficacy and Safety of Rina-S With or Without Bevacizumab Compared to Investigator's Choice of Platinum-based Chemotherapy With or](https://onco.cc/trials/nct07564141/), [Study to Compare the Efficacy and Safety of Olaparib When Given in Combination With Carboplatin and Paclitaxel, Compared With Carboplatin and Paclitax](https://onco.cc/trials/nct01081951/)
- ideas: [ctDNA-guided duration of PARP maintenance](https://onco.cc/ideas/idea-ctdna-guided-parp-duration/)
- pairings: [PARP inhibitor + bevacizumab maintenance (HRD-positive)](https://onco.cc/pairings/parp-plus-bevacizumab/)
- biomarkers: [Tumour (somatic or germline) BRCA1/2 mutation and HRR gene alterations](https://onco.cc/biomarkers/brca-somatic/)
- companies: [AGO Study Group](https://onco.cc/companies/ago-study-group/)

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JSON: https://onco.cc/api/v1/entities/platinum-sensitive-ovarian-cancer.json