Nanoscale Drug Delivery Systems for Ovarian Cancer: Targeting Strategies, Theranostic Platforms, and Translational...

Ovarian cancer remains the most lethal gynecologic malignancy, primarily due to late-stage diagnosis, peritoneal metastasis, and chemoresistance. Conventional chemotherapy is limited by poor targeting specificity and systemic toxicity, necessitating more precise therapeutic strategies. Nanoscale drug delivery systems (DDS) offer important opportunities to improve drug accumulation, reduce off-target effects, and integrate therapeutic and diagnostic functions. In this review, we summarize major carrier platforms together with delivery strategies and theranostic approaches, while placing particular emphasis on ovarian-cancer-specific challenges and the translational relevance of different DDS designs. We compare key carrier systems (including hydrogels, polymeric and inorganic nanoparticles, exosomes, and liposomes) according to their relevance to ovarian-cancer-specific challenges such as intraperitoneal delivery, peritoneal dissemination, and postoperative residual disease. We further examine how active targeting, tumor microenvironment-responsive release, and theranostic platforms may address these challenges, while critically assessing their practical limitations. Importantly, we highlight the major factors that continue to impede clinical translation, including biological heterogeneity, biosafety concerns, manufacturing scalability, and the limited predictive value of current preclinical models. By linking nanodesign strategies to ovarian-cancer-specific barriers and translational feasibility, this review aims to provide a more clinically relevant framework for the development of next-generation precision therapies.