Rethinking ovarian cancer III: the past decade and future directions

Despite major scientific advances, ovarian cancer remains a highly challenging disease. Future efforts must focus on earlier detection, overcoming treatment resistance, and developing more personalized and effective therapies.

A recent expert recommendation published in Nature Reviews Cancer reviews the progress made over the past decade in ovarian cancer research, with a focus on high-grade serous carcinoma (HGSC), the most common and deadliest form of the disease.

Significant progress, but survival remains limited

Despite the introduction of targeted therapies such as PARP inhibitors and advances in surgical techniques, outcomes remain poor. Only about 50% of patients survive beyond five years, and relapse occurs in up to 70% of cases.

One of the most important breakthroughs is the recognition that most ovarian cancers actually originate in the fallopian tubes rather than the ovaries. This has major implications for prevention strategies, including preventive removal of the fallopian tubes.

Researchers highlight the critical role of the tumour microenvironment—comprising immune cells, fibroblasts, and other components—in driving disease progression and treatment resistance. This complexity makes therapeutic targeting particularly challenging.

Immunotherapy: limited success so far

Unlike in other cancers, immune checkpoint inhibitors have shown disappointing results in ovarian cancer. New combination strategies and better patient selection are being explored to improve outcomes.

Resistance to chemotherapy and targeted therapies remains one of the biggest challenges. It involves a combination of genetic and non-genetic mechanisms that are still not fully understood.

Promising future directions

Key areas of innovation include:

• early detection using circulating DNA biomarkers
• therapies targeting the tumour microenvironment
• antibody–drug conjugates (ADCs)
• personalized vaccines and cell-based therapies

The global incidence of ovarian cancer is expected to increase by 40% by 2045, with significant disparities across regions and populations. Access to innovation remains uneven worldwide.

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