[Update on ovarian cancer]

The high value of surgery aimed at macroscopic complete resection is undisputed. The TRUST trial (Trial of Radical Upfront Surgical Therapy) aimed to determine the ideal timing of surgery (primary vs. interval debulking). While a significant progression-free survival benefit for primary surgery was demonstrated, the overall survival benefit was only numerical and not statistically significant. Based on the TRUST trial, primary surgery should still be recommended if macroscopic complete resection can be achieved with acceptable morbidity. Careful patient selection at specialized centers is crucial. A milestone in the systemic treatment of advanced ovarian cancer is the option of maintenance therapy with bevacizumab, poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors, or the combination of olaparib plus bevacizumab. Biomarker testing, specifically BRCA and homologous recombination deficiency (HRD) testing, is essential for treatment selection. In case of recurrence, where platinum-based chemotherapy is an option, platinum-containing combination chemotherapy should be administered, and the use of maintenance therapy should be considered. If platinum is not an option, three phase III trials have fortunately now demonstrated a significant overall survival benefit with the antibody-drug conjugate (ADC) mirvetuximab soravtansine (MIRV) in patients with high α‑folate receptor expression (MIRASOL trial), or with pembrolizumab plus paclitaxel ± bevacizumab in patients with CPS ≥ 1 (KEYNOTE-B96 trial), as well as with relacorilant plus nab-paclitaxel (ROSELLA trial), each compared to standard chemotherapy. MIRV and Pembrolizumab are already approved. The increasingly complex treatment of ovarian cancer should therefore be carried out in specialized German Cancer Society (DKG)-certified gynecological cancer centers as an effective tool for quality improvement.