How would you treat IIB ovarian carcinosarcoma which recurred locally at 1 month post initial debulking surgery, progressed through 2 cycles of adjuvant carbo/taxol, and is now s/p repeat debulking?

Platinum refractory ovarian cancers are incredibly challenging. In terms of more conventional chemotherapy options and based on the AURELIA trial, one could consider bevacizumab in combination with pegylated liposomal doxorubicin or topotecan. I would not use paclitaxel since the cancer is progressing on that agent. Unfortunately, the chance of response would be quite low. Given HER2 3+ on IHC staining, I would strongly favor trastuzumab deruxtecan as having the best chance of response. I would also encourage comprehensive NGS testing and testing folate receptor alpha expression, if not already done.

Also please consider a clinical trial for this patient; especially with HER2 targeted agent.