Simple SummaryThis study addresses the challenge of selecting the best maintenance therapy for ovarian cancer patients. The two medications under consideration are PARP inhibitors and bevacizumab. The aim is to provide clear guidelines based on scientific evidence that can help oncologists make informed treatment decisions. Upon evaluating various options, it is recommended that bevacizumab be spared for a second line maintenance therapy, while PARP inhibitors should be offered to all advanced ovarian cancer patients who have responded to initial platinum-based chemotherapy. The findings emphasize the importance of ongoing research to identify additional factors that can predict the effectiveness of bevacizumab. By following these guidelines, healthcare professionals can improve the outcomes and quality of life for ovarian cancer patients, contributing to better overall management of the disease and its impact on society.AbstractBackground: Maintenance therapy with PARP inhibitors and bevacizumab is approved for ovarian cancer treatment in the first and second line settings, but selecting the optimal sequence is challenging due to restrictions on using the same medication twice. This review aims to establish guidelines for ovarian cancer maintenance therapy based on the strength of scientific evidence, the most effective treatment strategy, and the impact on the healthcare system. Methods: Six questions were formulated to evaluate the scientific evidence supporting different maintenance therapy options using the AGREE II guideline evaluation tool. The questions address the acceptability of reusing the same medication, the efficacy of bevacizumab and PARP inhibitors in the first and second line settings, the comparative efficacy of these medications, the potential benefit of combination maintenance therapy, and the economic impact of maintenance therapy. Results: Based on the available evidence, bevacizumab should be preserved for second line maintenance therapy, and maintenance therapy with PARP inhibitors should be offered to all advanced ovarian cancer patients who have responded to first line platinum-based chemotherapy. Additional molecular predictors for bevacizumab efficacy are needed. Conclusions: The presented guidelines offer an evidence-based framework for selecting the most effective maintenance therapy for ovarian cancer patients. Further research is necessary to refine these recommendations and improve outcomes for patients with this disease.