ReviewInternational journal of women's health2026
Treatment Sequencing in Platinum-Resistant Epithelial Ovarian Cancer After MIRASOL, KEYNOTE-B96, and ROSELLA.
Review in International journal of women's health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Platinum-resistant epithelial ovarian cancer has long been managed as a clinically defined state with limited therapeutic differentiation. This narrative review aims to clarify how recent Phase III evidence should inform treatment allocation and sequencing after the MIRASOL, KEYNOTE-B96, and ROSELLA trials. Historically, treatment relied on non-platinum single-agent chemotherapy, with bevacizumab added for selected patients after AURELIA; however, this approach did not overcome short progression-free survival, limited response durability, cumulative toxicity, and the absence of robust biological selection. Recent randomized evidence has changed this landscape. MIRASOL established mirvetuximab soravtansine as a folate receptor alpha (FRα)-directed antibody-drug conjugate (ADC) for assay-defined FRα-positive platinum-resistant disease. KEYNOTE-B96 showed that pembrolizumab added to weekly paclitaxel, with or without bevacizumab, improves outcomes in programmed death ligand 1 (PD-L1) combined positive score (CPS)-positive platinum-resistant recurrent epithelial ovarian cancer. ROSELLA demonstrated that relacorilant, a selective glucocorticoid receptor (GR) antagonist, improves the activity of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in a population selected by clinical criteria rather than by a conventional tumor biomarker. Together, these trials define three distinct evidence anchors: FRα-targeted ADC therapy, PD-L1 CPS-selected chemoimmunotherapy, and tumor-biomarker-independent GR antagonism with nab-paclitaxel. They do not establish a simple hierarchy of preferred regimens. Instead, treatment sequencing should integrate biomarker eligibility, prior bevacizumab and poly (ADP-ribose) polymerase inhibitor exposure, taxane feasibility, ocular and immune-related toxicity risks, corticosteroid requirements, disease tempo, and patient priorities. The central challenge is to convert these validated options into rational, patient-specific sequencing strategies across biomarker-directed and tumor-biomarker-independent treatments.
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