Version July 2025
BRCA: breast cancer susceptibility gene; CA-125: cancer antigen 125; CT: computed tomography; FR: folate receptor; PARP: poly(ADP-ribose) polymerase.
* Most patients receive upfront surgery followed by adjuvant chemotherapy. However, in cases where disease is considered unlikely to be optimally cytoreduced, it may be administered as neoadjuvant therapy. For patients who undergo neoadjuvant chemotherapy and have optimal cytoreduction, we incorporate heated intraperitoneal chemotherapy at surgery.
¶ For patients at high risk of recurrence (eg, those with pleural effusions or ascites), we incorporate bevacizumab with chemotherapy and as maintenance therapy.
Δ Bevacizumab maintenance is continued until progression, while PARP inhibitor maintenance is continued until 2 years or progression, whichever comes first.
◊ Our approach to monitoring is clinical visits every 3 months for 2 years, then every 3 to 6 months for 3 years; CA-125 at visits if initially elevated. CT scans of the chest, abdomen, and pelvis as clinically indicated by signs or symptoms.
§ If bevacizumab was not previously administered with the initial line of treatment, we suggest its use for platinum-sensitive relapse in combination with chemotherapy and as maintenance.
¥ There are no data to inform use of PARP maintenance after platinum-sensitive relapse among patients who received these agents following initial platinum-based chemotherapy. In this setting, we consider features that may favor use to be longer time interval off of PARP inhibitors (eg, >12 months), previous good tolerability, and absence of a reversion mutation (such mutations, which restore BRCA protein expression, have been reported as resistance mechanisms to PARP inhibitors).
‡ Options include clinical trials (preferred), mirvetuximab soravtansine (for FR-alpha overexpressing cancers), paclitaxel, and pegylated liposomal doxorubicin.
