Find Recruiting Clinical Trials for Ovarian Cancer

Ovarian cancer trials are organized primarily by disease setting and molecular status. Frontline/newly diagnosed trials test intensification of carboplatin/paclitaxel with bevacizumab, PARP inhibitors (olaparib, niraparib, veliparib), immune checkpoint inhibitors, and novel agents — BRCA/HRD status often determines which maintenance arm patients enter. Platinum-sensitive recurrence trials (the largest category) test PARP inhibitor maintenance after re-response to platinum, platinum doublets with bevacizumab, and novel combinations. Platinum-resistant trials test mirvetuximab soravtansine (an ADC approved for FRα-positive platinum-resistant ovarian cancer), weekly paclitaxel/bevacizumab combinations, checkpoint inhibitor combinations, and other ADCs targeting different antigens (HER2, CEACAM5, NaPi2b). BRCA-positive patients have access to the broadest range of trials across all settings. Genomic profiling (NGS panel testing BRCA, HRD, and other alterations) is strongly recommended before trial searching. FRα (folate receptor alpha) expression testing by IHC is required for mirvetuximab-based trials.

BRCA1/2 mutation status is the single most important biomarker in ovarian cancer trial eligibility. Women with germline or somatic BRCA1/2 mutations — present in approximately 15–20% of ovarian cancer patients — are eligible for PARP inhibitor maintenance therapy (olaparib, niraparib, rucaparib) after response to platinum-based chemotherapy, in both frontline and recurrent settings. Importantly, PARP inhibitor eligibility extends beyond BRCA: homologous recombination deficiency (HRD) positive tumors — even without BRCA mutations — also derive benefit from PARP inhibitors in some settings. The Myriad myChoice CDx HRD test and FoundationOneCDx can identify HRD-positive patients. This means approximately 50% of HGSOC patients may be PARP inhibitor-eligible based on BRCA or HRD status. Patients without BRCA mutations (BRCAwt) and HRD-negative status still have trial options but are generally excluded from PARP inhibitor maintenance trials. BRCA testing should include both germline (blood) testing and somatic/tumor testing — somatic BRCA mutations found only in the tumor (not inherited) are equally relevant for PARP inhibitor eligibility.

Platinum sensitivity — the time elapsed between completing platinum-based chemotherapy and cancer recurrence — is the central organizing principle of recurrent ovarian cancer treatment and trial eligibility. Platinum-sensitive recurrence is defined as recurrence ≥6 months after completing the last platinum-containing regimen. These patients are generally retreatable with platinum-based chemotherapy and have the broadest trial access: platinum doublet trials (carboplatin + paclitaxel, carboplatin + gemcitabine, carboplatin + liposomal doxorubicin), PARP inhibitor maintenance trials after achieving response, and bevacizumab combinations. Platinum-resistant recurrence is defined as recurrence <6 months after completing platinum. These patients are typically treated with non-platinum single agents and have a more limited but still active trial landscape: mirvetuximab soravtansine (for FRα-positive disease), weekly paclitaxel with or without bevacizumab, checkpoint inhibitor combinations, and other ADCs. Platinum-refractory disease (progression during platinum therapy) is the most challenging setting. Treatment-free interval can also affect eligibility for specific trials, so knowing your exact dates of last platinum treatment and recurrence is important for trial screening.

HRD stands for homologous recombination deficiency — a state of impaired DNA double-strand break repair that makes cancer cells particularly sensitive to PARP inhibitors and platinum-based chemotherapy. While BRCA1/2 mutations are the most well-known cause of HRD, approximately 20–30% of HGSOC patients have HRD-positive tumors due to other mechanisms (RAD51 pathway alterations, epigenetic silencing). HRD testing quantifies the degree of genomic instability in the tumor using algorithms like the Myriad myChoice CDx (which measures loss of heterozygosity, telomeric allelic imbalance, and large-scale state transitions — collectively the "genomic instability score") or FoundationOneCDx. An HRD-positive result (Myriad GIS ≥33, or positive on equivalent platforms) alongside BRCA wildtype status may open eligibility for PARP inhibitor maintenance trials — particularly niraparib, which is approved for HRD-positive frontline maintenance. Testing requires a tumor tissue sample (formalin-fixed paraffin-embedded, FFPE) from the primary surgery or a biopsy. Patients whose tumor tissue is insufficient or unavailable may have limited options for HRD testing, though liquid biopsy-based approaches are emerging. If you have not had HRD testing, ask your oncologist about testing your archived tumor tissue.