Ovarian Carcinoma: Signal Pathways and Clinical Studies

Ovarian carcinoma is the most lethal gynecologic malignancy, with a 5-year survival rate for advanced patients that has remained stubbornly low due to high recurrence and acquired drug resistance. Despite advances in surgery and chemotherapy, a critical gap remains in translating an understanding of the tumor's complex molecular heterogeneity into effective, durable treatments. This review systematically dissects the latest advances in key signaling pathways driving ovarian carcinoma pathogenesis, including the Notch, HER2, DNA damage repair (DDR), PI3K/AKT/mTOR, and angiogenesis (VEGF) pathways, and critically evaluates the clinical progress of corresponding targeted therapies. We particularly focus on the regulatory networks within the tumor microenvironment and the mechanisms of crosstalk between pathways that contribute to treatment resistance. The review synthesizes clinical study outcomes for novel agents such as PARP inhibitors (olaparib and niraparib), antibody-drug conjugates (e.g., T-DXd), and anti-angiogenic therapies (bevacizumab), while analyzing the challenges of primary and acquired resistance. By bridging fundamental pathway biology with emerging clinical data, this review provides a strategic framework for advancing precision medicine and developing rational combination therapies to improve outcomes for patients with this devastating disease.