Gynecologic cancers in 2025: a year in review

Gynecologic cancers remain a leading cause of morbidity and mortality in women, and recent years have marked an inflection point through the consolidation of immunotherapy, the maturation of antibody-drug conjugates, and broader biomarker implementation. This narrative review synthesizes key clinical and translational advances across ovarian, endometrial, and cervical cancers in 2025, emphasizing implications for treatment selection and sequencing. In advanced ovarian cancer, TRUST re-examined surgical timing, supporting primary cytoreduction in selected resectable patients, whereas ICON8B suggested that weekly paclitaxel with carboplatin and bevacizumab may improve outcomes in high-risk disease. Platinum-resistant ovarian cancer saw the most disruptive progress: mirvetuximab soravtansine validated folate receptor-α as a therapeutic target, with overall survival benefit in high-expressing tumors; trastuzumab deruxtecan expanded actionable HER2 disease, with greatest activity in tumors rated 3+ by immunohistochemistry; and combination strategies, including relacorilant plus nab-paclitaxel and pembrolizumab plus weekly paclitaxel ± bevacizumab, delivered clinically meaningful survival signals, underscoring the need for harmonized biomarker strategies and proactive toxicity mitigation. In endometrial cancer, the Cancer Genome Atlas-based molecular classification increasingly informs risk stratification and adjuvant tailoring; long-term PORTEC-3 data refine escalation for p53-abnormal disease and de-escalation considerations for POLE-mutant tumors. In advanced disease, first-line chemo-immunotherapy has matured, with overall survival updates in mismatch repair-deficient tumors and a consistent progression-free survival benefit across diverse mismatch repair-proficient sub-groups, whereas adjuvant immunotherapy remains in evolution after KEYNOTE-B21. In cervical cancer, pembrolizumab added to definitive chemoradiotherapy set a new benchmark in locally advanced disease, and ultra-sensitive circulating tumor DNA analyses emerged as a powerful prognostic tool to enable post-treatment risk-adapted strategies. Collectively, the 2025 data set reinforces a "right therapy, right patient, right time" paradigm and prioritizes confirmatory antibody-drug conjugate trials, resistance biology, and dynamic biomarkers to translate gains into durable, equitable benefit.