Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: ASCO Guideline Clinical Insights.

Over the last decade, there has been a major shift in the up-front treatment of advanced epithelial ovarian cancer (EOC) in the United States, with a substantial decline in primary cytoreduction surgery (PCS) and significant rise in neoadjuvant chemotherapy (NACT) and interval cytoreduction surgery (ICS). NACT followed by ICS has now become the most common up-front treatment approach for advanced EOC. In addition to the publication of randomized trials supporting NACT, this shift may also be attributed to the COVID-19 pandemic, when the use of NACT increased to accommodate limited surgical resources. In 2025, ASCO published updated evidence-based recommendations on the use of NACT and ICS versus PCS and chemotherapy among patients with advanced ovarian cancer. This companion article addresses some of the questions that clinicians may face as they implement the recommendations into clinical practice. Key recommendations are included in Figure 1, and the recommendations are presented as an algorithm in Figure 2.