Advances in Systemic Therapy for Ovarian Cancer Over the Past Decade: A Clinical and Molecular Perspective

Epithelial ovarian cancer (EOC) remains a leading cause of gynecologic cancer mortality, with high rates of recurrence and chemoresistance. Advances in understanding the molecular biology of EOC, particularly BRCA mutations and homologous recombination deficiency (HRD), have led to more targeted therapies. This review provides an updated summary of systemic treatments for EOC, with an emphasis on personalized therapy approaches and emerging therapeutic strategies. This review synthesizes current research and clinical trials investigating molecular pathways in EOC, particularly focusing on HRD, BRCA status, and their impact on treatment selection, including the use of PARP inhibitors, chemotherapy, and immunotherapy. Recent studies demonstrate that PARP inhibitors, particularly in patients with BRCA mutations or HRD-positive tumors, have resulted in improved progression-free survival. Ongoing trials combining PARP inhibitors with immunotherapy and angiogenesis inhibitors show promise in extending treatment efficacy and overcoming resistance mechanisms. Despite these advances, recurrence remains common among patients with advanced ovarian cancer. The integration of genetic and molecular insights into systemic treatment is crucial in advancing the management of EOC. While targeted therapies have significantly improved patient outcomes, further research is necessary to optimize treatment strategies and address therapeutic resistance, particularly in patients with non-BRCA-mutated EOC. The future of EOC treatment lies in refining personalized therapies and improving predictive biomarkers for better patient selection.