Immune Evasion in Ovarian Cancer Peritoneal Metastasis: Mechanisms and Biomarker-Guided Therapeutic Matching

Area of Science:

• Oncology
• Immunology
• Cancer Biology

Background:

• Ovarian cancer peritoneal metastasis is a primary cause of death, with limited immunotherapy success.
• Immune resistance in ovarian cancer involves impaired antigen presentation, inhibitory receptors, and suppressive cells.
• Ascites and multicellular spheroids create unique microenvironments that hinder anti-tumor immunity.

Purpose of the Study:

• To synthesize evidence on immune escape mechanisms in ovarian cancer peritoneal metastasis.
• To explore the role of DNA damage response and homologous recombination deficiency in immune evasion.
• To propose a framework for combination immunotherapy based on specific biomarkers and mechanisms.

Main Methods:

• Literature synthesis of current evidence on immune resistance in ovarian cancer.
• Analysis of antigen presentation defects, T-cell exhaustion, and myeloid/regulatory cell circuits.
• Examination of ascites microenvironment, metabolic constraints, and DNA damage response interactions.

Main Results:

• Ovarian cancer peritoneal metastasis exhibits layered immune resistance, including antigen presentation issues and suppressive circuits.
• Metabolic reprogramming within ascites and multicellular spheroids contributes to immune suppression.
• Homologous recombination deficiency (HRD) intersects with innate immune sensing, impacting treatment strategies.

Conclusions:

• Understanding specific immune escape mechanisms is crucial for overcoming resistance in ovarian cancer peritoneal metastasis.
• A biomarker-guided approach linking tumor biology and immune status can optimize combination immunotherapy.
• Targeting ascites-specific features and dominant suppressive axes offers a roadmap for advanced ovarian cancer treatment.