A New Era of Treatment Sequencing in Platinum-Resistant Ovarian Cancer: Integrating Immunotherapy, Antibody–Drug Conjugates, and Targeted Therapies

Abstract

Simple Summary Platinum-resistant ovarian cancer (PROC) is no longer managed only with sequential single-agent chemotherapy. Randomized phase III trials now support pembrolizumab plus weekly paclitaxel with or without bevacizumab, mirvetuximab soravtansine for FRα-high disease, and relacorilant plus nab-paclitaxel, while HER2-directed trastuzumab deruxtecan provides an additional biomarker-defined option in selected patients. This review places these newer treatments alongside established chemotherapy and bevacizumab-based regimens and proposes a clinical framework for choosing among them. The framework considers biomarker eligibility, prior therapy, residual toxicity, visit and monitoring requirements, financial accessibility, and the likelihood that a patient will remain fit for subsequent treatment.