Nature Reviews Clinical Oncology, Published online: 17 June 2026; doi:10.1038/s41571-026-01168-5The therapeutic landscape of platinum-resistant ovarian cancer is rapidly evolving, with recent phase III trials demonstrating, for the first time, meaningful overall survival improvements beyond bevacizumab-based therapy. Herein we discuss how trials such as MIRASOL and, more recently, ENGOT-ov65/KEYNOTE-B96 and GOG30173/ENGOT-ov72/ROSELLA have established new standards of care through distinct biologically driven therapies and outline the new challenges that these approaches expose.