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Platinum-resistant ovarian cancer grows back within six months of platinum chemotherapy, or during it, and used to be treated with single chemotherapy drugs that shrink a tumour one time in ten. The antibody-drug conjugate mirvetuximab soravtansine, the cortisol-blocking drug relacorilant and pembrolizumab in PD-L1-positive tumours have each extended survival in phase 3 trials since 2023.
Resistance is defined by progression during platinum chemotherapy (refractory) or within six months of the last dose, though the boundary is arbitrary and the platinum-free interval is a continuum. Resistant tumours have usually restored DNA repair through BRCA reversion mutations, lost the drug-uptake pathways or acquired other changes after several lines of treatment, and prior PARP inhibitor exposure adds a further layer of cross-resistance. Symptoms come from peritoneal disease, bowel obstruction and ascites, and management is palliative in intent: control of disease, preservation of quality of life and, where possible, prolongation of survival. Single-agent weekly paclitaxel, pegylated liposomal doxorubicin, topotecan or gemcitabine each produce responses in roughly one patient in ten; AURELIA showed in 2014 that adding bevacizumab to any of them improves progression-free survival and symptom control, which became the standard for bevacizumab-naive patients.
MIRASOL was the first phase 3 trial to improve survival in this state with a new drug. Mirvetuximab soravtansine, an antibody-drug conjugate against folate receptor alpha, was compared with investigator's choice chemotherapy in women whose tumours expressed the receptor highly and who had had one to three prior lines; median overall survival was 16.46 months against 12.75, a hazard ratio of 0.67, with progression-free survival of 5.62 against 3.98 months and less haematological toxicity, though blurred vision and keratopathy require eye examinations and steroid drops. ROSELLA then tested relacorilant, a glucocorticoid receptor antagonist that reverses cortisol-driven chemoresistance, with nab-paclitaxel against nab-paclitaxel alone and extended median survival from 11.9 to 16.0 months, a hazard ratio of 0.69. KEYNOTE-B96 added pembrolizumab to weekly paclitaxel with or without bevacizumab and extended median survival in tumours with a combined positive score of one or more from 14.0 to 18.2 months, a hazard ratio of 0.76. Relacorilant and pembrolizumab both gained approvals in 2026.
The pipeline is dominated by antibody-drug conjugates: raludotatug deruxtecan against CDH6 in REJOICE-Ovarian01, rinatabart sesutecan and luveltamab tazevibulin against folate receptor alpha in RAINFOL-01 and other trials, and agents against B7-H4 and TROP2, with the question of how to sequence them when they share payloads. Secondary surgery has no role, hyperthermic intraperitoneal chemotherapy is unproven here, and hormonal therapy has a small place in low-grade and receptor-positive tumours. Early palliative care, management of malignant bowel obstruction and honest discussion of goals remain the core of care for a state that is still incurable.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Mirvetuximab soravtansine with ophthalmic monitoring (MIRASOL).
Pembrolizumab with weekly paclitaxel, with bevacizumab where not previously given (KEYNOTE-B96).
Relacorilant with nab-paclitaxel (ROSELLA); or single-agent weekly paclitaxel, pegylated liposomal doxorubicin, topotecan or gemcitabine with bevacizumab if bevacizumab-naive (AURELIA).
Clinical trials of antibody-drug conjugates against CDH6, folate receptor alpha, B7-H4 and TROP2; hormonal therapy in receptor-positive low-grade disease.
Early palliative care, drainage of ascites, management of bowel obstruction and nutritional support alongside anticancer treatment.
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.
The targets of this cancer's medicines and the ones linked to it directly.
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.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
A swollen painful calf, or sudden breathlessness with chest pain; the tamoxifen boxed warning covers pulmonary embolism and stroke.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
See all on the product pages:BevacizumabGemcitabineLetrozole (and other aromatase inhibitors)Luveltamab tazevibulinMirvetuximab soravtansinePaclitaxel / nab-paclitaxelPegylated liposomal doxorubicinPembrolizumabRaludotatug deruxtecanRinatabart sesutecanTopotecan·Printable cards in the navigator
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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.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.