Platinum-resistant ovarian relapse — Platinum-Free Interval (PFI) <6 months from last pla...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-OVARIAN-PLATINUM-RESISTANT`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-OVARIAN`
Sources	`SRC-AURELIA-PUJADE-LAURAINE-2014` `SRC-ESMO-OVARIAN-2024` `SRC-MIRASOL-MOORE-2024` `SRC-NCCN-OVARIAN-2025`

Red Flag Origin

Definition	Platinum-resistant ovarian relapse — Platinum-Free Interval (PFI) <6 months from last platinum dose. Re-platinum non-curative; treatment shifts to single-agent non-platinum chemo (PLD, weekly paclitaxel, topotecan, gemcitabine) ± bevacizumab (AURELIA — mPFS 6.7 vs 3.4 mo) OR mirvetuximab if FRα-high (MIRASOL).
Clinical direction	de-escalate
Category	transformation-progression
Shifts algorithm	ALGO-OVARIAN-2L

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "platinum_free_interval_months",
      "threshold": 6
    },
    {
      "finding": "platinum_status",
      "value": "resistant"
    }
  ],
  "type": "composite_score"
}

Notes

Platinum-refractory (PFI <1 mo) is a worse subset — palliative intent dominates; clinical-trial enrollment encouraged. AURELIA — bev added to single-agent chemo improved PFS but not OS overall; patient symptom-burden (ascites, bowel obstruction) often drives bev decision. clinical-direction "de-escalate" reflects shift away from intensive platinum doublet toward single-agent palliative intent. Mirvetuximab (MIRASOL) is the first regimen with OS benefit in this setting (FRα-high subset). Sacituzumab govitecan, oregovomab, anti-VEGF combinations under study.

Used By

Algorithms

ALGO-OVARIAN-2L - ALGO-OVARIAN-2L