ADCs are rapidly transforming treatment strategies for recurrent ovarian cancer, particularly in biomarker-selected populations. Data presented at the recent Society for Gynecologic Oncology (SGO) 2026 Annual Meeting on Women’s Cancer highlight the growing role of ADCs in both platinum-resistant disease and emerging maintenance settings.

Following these presentations, featured expert Melissa A. Geller, MD, MS, FACOG, was interviewed by Conference Reporter Medical Director Lauren Weinand, MD. Clinical perspectives from Dr Geller on these findings are presented here.

What really came through at the SGO 2026 Annual Meeting on Women’s Cancer is this important shift in ovarian cancer treatment: ADCs have moved from being investigational to being firmly established in the platinum-resistant ovarian cancer setting for biomarker-selected patients.

There are multiple ADCs out there, many of which target FRα. FRα is overexpressed in approximately 75% to 90% of epithelial ovarian cancers, particularly high-grade serous tumors. Data from the phase 3 MIRASOL clinical trial solidified the ADC mirvetuximab soravtansine (MIRV) as the standard of care (SOC) for patients with FRα+, platinum-resistant, recurrent ovarian cancer previously treated with 1 to 3 lines of therapy. This was based on its median overall survival advantage over chemotherapy in MIRASOL (ie, 16.46 months vs 12.75 months, respectively). Trastuzumab deruxtecan has also been approved by the US Food and Drug Administration (FDA) for HER2+ (immunohistochemistry [IHC] 3+) unresectable/metastatic solid tumors, including ovarian cancer. This was based on the primary analysis of the phase 2 DESTINY-PanTumor02 trial, which showed a durable clinical benefit, especially in the IHC 3+ patient population.

One exciting presentation at this year’s SGO meeting was by Cara Mathews, MD, on the first disclosure from cohort D2 of the phase 1/2 RAINFOL-01 study, which looked at rinatabart sesutecan (Rina-S) plus bevacizumab in patients with recurrent ovarian cancer (abstract 135). Rina-S is an ADC that targets FRα with a novel hydrophilic protease-cleavable linker and the TOP1 inhibitor exatecan as the payload. Cohort D2 included heavily pretreated patients, including those with primary platinum-refractory ovarian cancer, platinum-resistant ovarian cancer, as well as platinum-sensitive ovarian cancer whose disease had progressed after prior therapies.

Previous data from the dose-expansion study, which was presented at the SGO 2025 Annual Meeting on Women’s Cancer, showed a promising response rate for Rina-S monotherapy in heavily pretreated patients; what investigators presented at SGO 2026 were the safety results from the combination therapy. Importantly, there were no new signals for ocular toxicity, peripheral neuropathy, or interstitial lung disease. The most common (≥20%) treatment-emergent adverse events were fatigue, nausea, and hematologic toxicities, which I think are easier to manage than the ocular toxicity, peripheral neuropathy, and interstitial lung disease that have been reported with other FRα ADCs. The key takeaway here is that in a difficult-to-treat and heterogeneous patient population, the addition of bevacizumab to Rina-S is generally well tolerated.

The study design for the phase 3 RAINFOL-04/GOG-3134 trial by Toon Van Gorp, MD, PhD, and colleagues was also presented at the SGO 2026 Annual Meeting on Women’s Cancer during a Trials in Progress session (poster 265). This is an ongoing open-label study in patients with platinum-sensitive recurrent ovarian cancer who were previously treated with platinum-based chemotherapy. In RAINFOL-04, patients are being randomized 1:1 to receive Rina-S (regardless of FRα expression) plus bevacizumab or observation vs the SOC (ie, bevacizumab or observation). The primary end point will be progression-free survival. I think that this study is important because it will potentially give us a new maintenance option following disease recurrence in patients with platinum-sensitive ovarian cancer.

Another theme that arose at this year’s SGO meeting is the sequencing of ADCs. I think that this is going to become the million-dollar question: How do we sequence these drugs? Should we be moving ADCs earlier, even in the platinum-sensitive space? If sequencing is really shifting, with PARP inhibitors being used in the frontline setting and ADCs being used earlier at the time of recurrence in FRα+ disease, it forces us to reexamine how we selectively use antiangiogenics and how we sequence the therapies we currently have as SOC for platinum-resistant recurrent ovarian cancer.

Another presentation at the SGO 2026 Annual Meeting on Women’s Cancer by Julia Sakach, MD, looked at treatment sequencing in patients with platinum-resistant ovarian cancer who received both MIRV with or without bevacizumab and weekly paclitaxel with or without bevacizumab (poster 1109). In this single-institution retrospective review, investigators found that, although not statistically significant, there was a trend toward a better overall response rate and progression-free survival for patients receiving weekly paclitaxel prior to MIRV. Ultimately, these data underscore the critical need to integrate sequencing strategies into future clinical trial designs.