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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Usually found late. PARP inhibitors transformed maintenance therapy, and ADCs against folate receptor and CDH6 are arriving for platinum-resistant disease.
Ovarian cancer is a group of diseases (~320,000 new cases a year) dominated by high-grade serous carcinoma, which arises in the fallopian tube, is almost always TP53-mutant, and is diagnosed at stage III-IV in three-quarters of women because there is no symptom or screening test that catches it early. Roughly half of high-grade serous tumours have homologous recombination deficiency, including ~20% with germline or somatic BRCA1/2 mutations. Low-grade serous, endometrioid, clear-cell, and mucinous carcinomas are biologically distinct and respond differently to treatment.
The standard of care is maximal cytoreductive surgery (primary or interval, after neoadjuvant carboplatin-paclitaxel), sometimes with HIPEC, followed by maintenance therapy chosen by biomarker: olaparib for BRCA-mutated disease (SOLO-1, 7-year OS 67% vs 47%), olaparib plus bevacizumab for HRD-positive disease (PAOLA-1), niraparib for the rest with declining enthusiasm after PRIMA showed no survival gain. Platinum-sensitive relapse is treated with platinum doublets and secondary surgery in selected patients (DESKTOP III); PARP inhibitors are re-used less since later-line safety signals. Platinum-resistant disease, historically the hardest setting, now has three new options with survival benefit: mirvetuximab soravtansine for FRα-high tumours (MIRASOL), relacorilant plus nab-paclitaxel (ROSELLA, approved 2026), and pembrolizumab plus weekly paclitaxel for PD-L1-positive tumours (KEYNOTE-B96, approved February 2026, the first immunotherapy in ovarian cancer). Low-grade serous carcinoma gained its first dedicated therapy in avutometinib plus defactinib (2025).
| Setting | Approach | Guideline |
|---|---|---|
| Newly diagnosed | Surgery + platinum-taxane ± bevacizumab ± HIPEC; PARP maintenance by HRD status. | not mapped |
| Platinum-sensitive relapse | Platinum doublet + PARP maintenance; secondary cytoreduction in selected cases. | not mapped |
| Platinum-resistant | Mirvetuximab (FRα-high), relacorilant + nab-paclitaxel, pembrolizumab (PD-L1+), single-agent chemotherapy. | ESMO-MCBS 2 (SORAYA mirvetuximab, single-arm) |
| 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 v2.2026 |
| 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 |
| 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) |
| First-line maintenance, BRCA-mutated | Olaparib 2 years (SOLO-1) or olaparib + bevacizumab (PAOLA-1) or niraparib 3 years (PRIMA). | NCCN 1, ESMO-MCBS A |
| First-line maintenance, HRD-positive BRCA-wild-type | Olaparib + bevacizumab (PAOLA-1, OS benefit) or niraparib (PRIMA, PFS only). | NCCN 1 |