Advances in current and emerging immunotherapies for ovarian cancer

Ovarian cancer persists as the most lethal gynecologic malignancy, a status attributable to its proficient immune evasion and the development of therapeutic resistance. The immune evasion is orchestrated by a profoundly immunosuppressive tumor microenvironment (TME) that accelerates tumor progression and metastasis. Although immunotherapies, particularly immune checkpoint inhibitors (ICIs), have shown promise in other solid tumors, their clinical benefit in ovarian cancer as monotherapies has been limited by low response rates and complex adaptive resistance mechanisms. This review provides an overview of the immunological characteristics of the ovarian cancer TME and summarizes current immunotherapeutic approaches. Moreover, emerging strategies designed to overcome immune evasion, including cancer vaccines, oncolytic viruses (OVs), adoptive cell therapy, and bispecific antibodies, are discussed. In addition, this review outlines the challenges and future directions of immunotherapy in ovarian cancer, offering strategies to overcome resistance and advance precision medicine.