New frontiers in the management of recurrent epithelial ovarian cancer: a comprehensive review

Ovarian cancer recurs in approximately 70% of cases. In platinum-sensitive relapse, platinum-based therapy remains the backbone of treatment, with optional integration of secondary cytoreductive surgery achieving complete resection and/or hyperthermic intraperitoneal chemotherapy, although evidence remains conflicting. Bevacizumab combined with chemotherapy improves progression-free survival (PFS) but not overall survival (OS). Poly(ADP-ribose) polymerase inhibitor (PARPi) maintenance significantly prolongs PFS in patients with germline or somatic BRCA mutations; its use is currently restricted to this subgroup. Immune checkpoint inhibitors have failed to demonstrate benefit in phase III trials. In platinum-resistant ovarian cancer (PROC), platinum rechallenge retains activity in selected patients. Bevacizumab with chemotherapy improves PFS without OS benefit. Novel antibody-drug conjugates (ADCs) are emerging as promising options: mirvetuximab soravtansine significantly improved PFS (5.6 vs 4.0 months) and OS (16.5 vs 12.8 months) compared with chemotherapy in folate receptor alpha-high PROC (MIRASOL). Trastuzumab deruxtecan has shown high response rates in HER2-expressing disease. Other ADCs and targeted agents, including the WEE1 inhibitor adavosertib, are currently under evaluation. Biomarker-driven therapies are reshaping the management of recurrent ovarian cancer. Future strategies should prioritise improved patient selection and earlier integration of targeted therapies.