Metastatic ovarian cancer is usually advanced epithelial ovarian carcinoma, most often high-grade serous ovarian cancer, with dominant transcoelomic spread throughout the peritoneal cavity. Its metastatic biology is characterized by ascitic shedding, multicellular spheroid formation, mesothelial and extracellular matrix interactions, EMT-like plasticity, homologous recombination defects in BRCA-associated cases, and recurrent platinum resistance.
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name: Metastatic Ovarian Cancer
creation_date: '2026-03-28T21:40:00Z'
updated_date: '2026-05-10T08:48:15Z'
description: >-
Metastatic ovarian cancer is usually advanced epithelial ovarian carcinoma, most
often
high-grade serous ovarian cancer, with dominant transcoelomic spread throughout
the
peritoneal cavity. Its metastatic biology is characterized by ascitic shedding,
multicellular
spheroid formation, mesothelial and extracellular matrix interactions, EMT-like
plasticity,
homologous recombination defects in BRCA-associated cases, and recurrent platinum
resistance.
categories:
- Gynecologic Cancer
- Metastatic Cancer
- Solid Tumor
parents:
- ovarian carcinoma
disease_term:
preferred_term: metastatic ovarian cancer
term:
id: MONDO:0005211
label: ovarian serous adenocarcinoma
mappings:
mondo_mappings:
- term:
id: MONDO:0005211
label: ovarian serous adenocarcinoma
mapping_predicate: skos:closeMatch
mapping_source: MONDO
mapping_justification: High-grade serous ovarian carcinoma is the dominant biology underlying most metastatic ovarian cancer.
prevalence:
- population: Ovarian cancer at diagnosis
percentage: 80
notes: About 80% of patients present with advanced-stage disease.
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: At diagnosis, approximately 95% of patients experience nonspecific symptoms, such as abdominal pain, bloating, and urinary urgency and frequency, and about 80% have advanced-stage disease (stage III-IV), including extrapelvic disease, ascites, and abdominal masses.
explanation: This supports the predominance of advanced disseminated presentation in ovarian cancer.
- population: Advanced-stage ovarian cancer
percentage: 40
notes: Reported upper bound of 5-year overall survival with current therapy for advanced-stage disease.
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: With treatment, the 5-year overall survival rate for advanced-stage ovarian cancer is 10% to 40%.
explanation: This provides a current long-term survival range for advanced ovarian cancer.
pathophysiology:
- name: Transcoelomic Dissemination and Spheroid Formation
description: >-
Ovarian cancer typically metastasizes by shedding into ascites rather than first
through
the bloodstream. Tumor cells form multicellular spheroids that survive in suspension
and
implant across peritoneal surfaces.
evidence:
- reference: PMID:27612856
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Epithelial ovarian cancer (EOC) dissemination is primarily mediated by the shedding of tumor cells from the primary site into ascites where they form multicellular spheroids that rapidly lead to peritoneal carcinomatosis.
explanation: This directly supports the dominant transcoelomic mechanism of ovarian cancer metastasis.
biological_processes:
- preferred_term: cell migration
modifier: INCREASED
term:
id: GO:0016477
label: cell migration
- name: Mesothelial Crosstalk and Platinum Resistance
description: >-
Disseminated ovarian cancer cells engage mesothelial and stromal cells within
the
peritoneum, creating FN1-AKT and related survival programs that protect tumor
cells from
platinum-induced apoptosis.
evidence:
- reference: PMID:31904865
supports: SUPPORT
evidence_source: IN_VITRO
snippet: Mechanistically, OCAMs can induce decreased platinum-sensitivity in OvCa cells via induction of the FN1/Akt signaling pathway via cell-to-cell interactions.
explanation: This supports a direct microenvironmental mechanism of platinum resistance in peritoneal metastasis.
biological_processes:
- preferred_term: positive regulation of cell migration
modifier: INCREASED
term:
id: GO:0030335
label: positive regulation of cell migration
- name: EMT and Mesenchymal Plasticity
description: >-
EMT-like transcriptional programs facilitate detachment, invasion, and mesothelial
implantation, while also contributing to treatment resistance and recurrence.
evidence:
- reference: PMID:41687476
supports: SUPPORT
evidence_source: OTHER
snippet: In ovarian cancer, this shift may be one of the reasons the disease spreads so readily and comes back despite intensive treatment.
explanation: This supports EMT as a contributor to ovarian cancer dissemination and recurrence after treatment.
biological_processes:
- preferred_term: epithelial to mesenchymal transition
modifier: INCREASED
term:
id: GO:0001837
label: epithelial to mesenchymal transition
- name: BRCA-Associated Homologous Recombination Deficiency
description: >-
BRCA1/2-deficient metastatic ovarian cancers exhibit homologous recombination
deficiency,
increased platinum sensitivity, and marked susceptibility to PARP inhibition,
although
acquired resistance eventually emerges in many cases.
evidence:
- reference: PMID:38174379
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: All PARPis showed significant benefit, with olaparib showing greater benefit in newly diagnosed and PSR OC women.
explanation: This supports the clinically important BRCA-associated HRD subset in metastatic ovarian cancer.
biological_processes:
- preferred_term: signal transduction
modifier: ABNORMAL
term:
id: GO:0007165
label: signal transduction
- name: Tumor Angiogenesis
description: >-
Ovarian cancer metastases depend on angiogenic support within the peritoneal cavity,
and anti-VEGF therapy remains part of maintenance treatment for advanced-stage
disease.
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Most patients with advanced-stage ovarian cancer receive maintenance therapy with bevacizumab (a monoclonal antibody that blocks angiogenesis) and/or poly-adenosine diphosphate ribose polymerase (PARP) inhibitors.
explanation: The clinical use of bevacizumab maintenance therapy supports angiogenesis as a key dependency of advanced ovarian cancer.
biological_processes:
- preferred_term: angiogenesis
modifier: INCREASED
term:
id: GO:0001525
label: angiogenesis
- name: Immune Evasion
description: >-
Metastatic ovarian cancer develops an immunosuppressive microenvironment in which
myeloid-derived suppressor cells accumulate and blunt antitumor immune responses.
evidence:
- reference: PMID:37508575
supports: SUPPORT
evidence_source: OTHER
snippet: Consequently, the high abundance of these cells often leads to immunosuppression, tumor growth, treatment failure, and poor prognosis.
explanation: This ovarian cancer review supports immune evasion through accumulation of immunosuppressive myeloid-derived suppressor cells in the tumor microenvironment.
biological_processes:
- preferred_term: negative regulation of immune response
modifier: INCREASED
term:
id: GO:0050777
label: negative regulation of immune response
phenotypes:
- category: Gastrointestinal
name: Ascites
frequency: VERY_FREQUENT
description: Ascites is a hallmark of peritoneal dissemination in advanced ovarian cancer.
phenotype_term:
preferred_term: Ascites
term:
id: HP:0001541
label: Ascites
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: At diagnosis, approximately 95% of patients experience nonspecific symptoms, such as abdominal pain, bloating, and urinary urgency and frequency, and about 80% have advanced-stage disease (stage III-IV), including extrapelvic disease, ascites, and abdominal masses.
explanation: This documents ascites as a common feature of advanced-stage ovarian cancer at diagnosis.
- category: Gastrointestinal
name: Abdominal pain
frequency: VERY_FREQUENT
description: Abdominal pain and bloating are common symptoms of metastatic ovarian cancer.
phenotype_term:
preferred_term: Abdominal pain
term:
id: HP:0002027
label: Abdominal pain
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: At diagnosis, approximately 95% of patients experience nonspecific symptoms, such as abdominal pain, bloating, and urinary urgency and frequency, and about 80% have advanced-stage disease (stage III-IV), including extrapelvic disease, ascites, and abdominal masses.
explanation: This documents abdominal pain as one of the predominant presenting symptoms of ovarian cancer.
- category: Constitutional
name: Weight loss
frequency: FREQUENT
description: Advanced ovarian cancer often causes weight loss and sarcopenia.
phenotype_term:
preferred_term: Weight loss
term:
id: HP:0001824
label: Weight loss
- category: Constitutional
name: Fatigue
frequency: VERY_FREQUENT
description: Fatigue is common with advanced disease and repeated platinum-based therapy.
phenotype_term:
preferred_term: Fatigue
term:
id: HP:0012378
label: Fatigue
genetic:
- name: TP53
association: Near-universal somatic mutation in HGSOC
notes: TP53 alteration is the foundational lesion in most metastatic high-grade serous ovarian cancers.
evidence:
- reference: PMID:36804485
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: High-grade serous ovarian carcinoma is a unique cancer characterised by universal TP53 mutations and widespread copy number alterations.
explanation: This supports TP53 mutation as the foundational, near-universal genetic lesion in HGSOC.
- name: BRCA1
association: Germline or somatic loss of function
notes: BRCA1 deficiency drives homologous recombination defects and PARP inhibitor sensitivity.
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Hereditary factors are associated with 25% of cases, predominantly linked to BRCA1/2 gene variants.
explanation: This supports BRCA1 as a major hereditary driver of ovarian cancer.
- name: BRCA2
association: Germline or somatic loss of function
notes: BRCA2 deficiency similarly creates HRD and can improve platinum/PARP responsiveness.
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Hereditary factors are associated with 25% of cases, predominantly linked to BRCA1/2 gene variants.
explanation: This supports BRCA2 as a major hereditary driver of ovarian cancer.
- name: CCNE1
association: Amplification
notes: CCNE1 amplification is linked to HR-proficient, platinum-resistant metastatic disease.
evidence:
- reference: PMID:36804485
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Forty-four genes are found to have evidence as amplified therapeutic targets; the five highest scoring genes are CCNE1, PAX8, URI1, PRKCI and FAL1.
explanation: This supports CCNE1 as the top-ranked amplified driver oncogene in HGSOC.
environmental:
- name: Endometriosis
notes: Endometriosis is a recognized risk factor for selected epithelial ovarian cancer subtypes.
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Risk factors include older age, family history of breast or ovarian cancer, endometriosis, and nulliparity.
explanation: This supports endometriosis as a recognized risk factor for ovarian cancer.
- name: Nulliparity
notes: Nulliparity increases lifetime ovulatory exposure and ovarian cancer risk.
evidence:
- reference: PMID:40690248
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Risk factors include older age, family history of breast or ovarian cancer, endometriosis, and nulliparity.
explanation: This supports nulliparity as a recognized risk factor for ovarian cancer.
notes: >-
Although ovarian cancer can spread hematogenously late in its course, its defining
metastatic
biology is transcoelomic. High-grade serous tumors dominate this phenotype and explain
the
choice of MONDO ovarian serous adenocarcinoma as the structured disease term.
treatments:
- name: PARP Inhibitor Maintenance for BRCA-Mutated or HRD Disease
description: PARP inhibitor maintenance therapy is used in advanced or metastatic ovarian cancer with BRCA mutation or homologous recombination deficiency, exploiting impaired DNA repair to prolong disease control after platinum-responsive therapy.
treatment_term:
preferred_term: targeted therapy
term:
id: NCIT:C93352
label: Targeted Therapy
therapeutic_agent:
- preferred_term: olaparib
term:
id: CHEBI:83766
label: olaparib
- preferred_term: niraparib
term:
id: CHEBI:176844
label: niraparib
- preferred_term: rucaparib
term:
id: CHEBI:134689
label: rucaparib
evidence:
- reference: DOI:10.3390/cancers15123095
reference_title: Prevalence of Homologous Recombination Deficiency in First-Line PARP Inhibitor Maintenance Clinical Trials and Further Implication of Personalized Treatment in Ovarian Cancer
supports: SUPPORT
evidence_source: OTHER
snippet: Among ovarian cancer patients with BRCA mutation or homologous recombination deficiency (HRD), the efficacy of Poly-ADP-ribose polymerase (PARP) inhibitors such as olaparib, niraparib, veliparib, and rucaparib has been proven in a number of clinical trials.
explanation: Review-level synthesis supports PARP inhibitor maintenance as a treatment class for BRCA-mutated or HRD ovarian cancer.
references:
- reference: DOI:10.1007/s00330-024-11300-7
title: 'Ovarian cancer staging and follow-up: updated guidelines from the European Society of Urogenital Radiology female pelvic imaging working group'
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: To provide up-to-date European Society of Urogenital Radiology (ESUR) guidelines for staging and follow-up of patients with ovarian cancer (OC).
supporting_text: To provide up-to-date European Society of Urogenital Radiology (ESUR) guidelines for staging and follow-up of patients with ovarian cancer (OC).
evidence:
- reference: DOI:10.1007/s00330-024-11300-7
reference_title: 'Ovarian cancer staging and follow-up: updated guidelines from the European Society of Urogenital Radiology female pelvic imaging working group'
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: To provide up-to-date European Society of Urogenital Radiology (ESUR) guidelines for staging and follow-up of patients with ovarian cancer (OC).
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.1007/s12094-024-03531-3
title: SEOM–GEICO clinical guideline on epithelial ovarian cancer (2023)
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: In recent years, the incorporation of new strategies to the therapeutic armamentarium has completely changed the outcomes of epithelial ovarian cancer (EOC).
supporting_text: In recent years, the incorporation of new strategies to the therapeutic armamentarium has completely changed the outcomes of epithelial ovarian cancer (EOC).
evidence:
- reference: DOI:10.1007/s12094-024-03531-3
reference_title: SEOM–GEICO clinical guideline on epithelial ovarian cancer (2023)
supports: SUPPORT
evidence_source: OTHER
snippet: In recent years, the incorporation of new strategies to the therapeutic armamentarium has completely changed the outcomes of epithelial ovarian cancer (EOC).
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.1056/nejmoa2309169
title: Mirvetuximab Soravtansine in FRα-Positive, Platinum-Resistant Ovarian Cancer
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: Mirvetuximab Soravtansine in FRα-Positive, Platinum-Resistant Ovarian Cancer
supporting_text: Mirvetuximab Soravtansine in FRα-Positive, Platinum-Resistant Ovarian Cancer
- reference: DOI:10.1136/ijgc-2024-005401
title: 'Mirvetuximab soravtansine in folate receptor alpha (FRα)–high platinum-resistant ovarian cancer: final overall survival and post hoc sequence of therapy subgroup results from the SORAYA trial'
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: 'Mirvetuximab soravtansine in folate receptor alpha (FRα)–high platinum-resistant ovarian cancer: final overall survival and post hoc sequence of therapy subgroup results from the SORAYA trial'
supporting_text: The single-arm, phase II SORAYA trial ( NCT04296890 ) of mirvetuximab soravtansine-gynx in folate receptor alpha (FRα)–high platinum-resistant ovarian cancer (n=105 (efficacy-evaluable)) met its primary endpoint with an objective response rate of 32.4% (95% CI, 23.6 to 42.2).
evidence:
- reference: DOI:10.1136/ijgc-2024-005401
reference_title: 'Mirvetuximab soravtansine in folate receptor alpha (FRα)–high platinum-resistant ovarian cancer: final overall survival and post hoc sequence of therapy subgroup results from the SORAYA trial'
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: The single-arm, phase II SORAYA trial ( NCT04296890 ) of mirvetuximab soravtansine-gynx in folate receptor alpha (FRα)–high platinum-resistant ovarian cancer (n=105 (efficacy-evaluable)) met its primary endpoint with an objective response rate of 32.4% (95% CI, 23.6 to 42.2).
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.1186/s12905-024-03199-5
title: 'Effect of different treatment modalities on the prognosis of stage IV epithelial ovarian cancer: analysis of the SEER database'
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: The prognosis of advanced ovarian cancer is often poor.
supporting_text: The prognosis of advanced ovarian cancer is often poor.
evidence:
- reference: DOI:10.1186/s12905-024-03199-5
reference_title: 'Effect of different treatment modalities on the prognosis of stage IV epithelial ovarian cancer: analysis of the SEER database'
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: The prognosis of advanced ovarian cancer is often poor.
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.1200/jco-24-02589
title: 'Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: ASCO Guideline Update'
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual .
supporting_text: ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual .
- reference: DOI:10.1200/jco.22.01900
title: 'Efficacy and Safety of Mirvetuximab Soravtansine in Patients With Platinum-Resistant Ovarian Cancer With High Folate Receptor Alpha Expression: Results From the SORAYA Study'
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: Single-agent chemotherapies have limited activity and considerable toxicity in patients with platinum-resistant epithelial ovarian cancer (PROC).
supporting_text: Single-agent chemotherapies have limited activity and considerable toxicity in patients with platinum-resistant epithelial ovarian cancer (PROC).
evidence:
- reference: DOI:10.1200/jco.22.01900
reference_title: 'Efficacy and Safety of Mirvetuximab Soravtansine in Patients With Platinum-Resistant Ovarian Cancer With High Folate Receptor Alpha Expression: Results From the SORAYA Study'
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Single-agent chemotherapies have limited activity and considerable toxicity in patients with platinum-resistant epithelial ovarian cancer (PROC).
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.1891/cjnpwh-2506
title: Ovarian Cancer Risk Assessment, Risk Reduction, and Early Detection
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: Nurse practitioners (NPs) who provide women’s healthcare have an essential role in cancer risk assessment, risk reduction for prevention, and early detection.
supporting_text: Nurse practitioners (NPs) who provide women’s healthcare have an essential role in cancer risk assessment, risk reduction for prevention, and early detection.
evidence:
- reference: DOI:10.1891/cjnpwh-2506
reference_title: Ovarian Cancer Risk Assessment, Risk Reduction, and Early Detection
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Nurse practitioners (NPs) who provide women’s healthcare have an essential role in cancer risk assessment, risk reduction for prevention, and early detection.
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.20892/j.issn.2095-3941.2025.0619
title: 'Global epidemiology of ovarian cancer: patterns, trends, and risk factors'
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: Ovarian cancer was the eighth most frequently diagnosed cancer among women in 2022.
supporting_text: Ovarian cancer was the eighth most frequently diagnosed cancer among women in 2022.
evidence:
- reference: DOI:10.20892/j.issn.2095-3941.2025.0619
reference_title: 'Global epidemiology of ovarian cancer: patterns, trends, and risk factors'
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Ovarian cancer was the eighth most frequently diagnosed cancer among women in 2022.
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.3389/fonc.2024.1421828
title: 'Does a high peritoneal cancer index lead to a worse prognosis of patients with advanced ovarian cancer?: a systematic review and meta-analysis based on the latest evidence'
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: 'Does a high peritoneal cancer index lead to a worse prognosis of patients with advanced ovarian cancer?: a systematic review and meta-analysis based on the latest evidence'
supporting_text: The newest clinical evidence that the relationship between the peritoneal cancer index (PCI) and the postoperative prognosis of advanced ovarian cancer patients remains controversial, and there are no large-sample and multicenter studies to clarify this matter.
evidence:
- reference: DOI:10.3389/fonc.2024.1421828
reference_title: 'Does a high peritoneal cancer index lead to a worse prognosis of patients with advanced ovarian cancer?: a systematic review and meta-analysis based on the latest evidence'
supports: SUPPORT
evidence_source: OTHER
snippet: The newest clinical evidence that the relationship between the peritoneal cancer index (PCI) and the postoperative prognosis of advanced ovarian cancer patients remains controversial, and there are no large-sample and multicenter studies to clarify this matter.
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.3390/cancers15020407
title: Diagnostic and Therapeutic Pathway of Advanced Ovarian Cancer with Peritoneal Metastases
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: Over two thirds of ovarian cancer patients present with advanced stage disease at the time of diagnosis.
supporting_text: Over two thirds of ovarian cancer patients present with advanced stage disease at the time of diagnosis.
evidence:
- reference: DOI:10.3390/cancers15020407
reference_title: Diagnostic and Therapeutic Pathway of Advanced Ovarian Cancer with Peritoneal Metastases
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Over two thirds of ovarian cancer patients present with advanced stage disease at the time of diagnosis.
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.3390/cancers15030706
title: A Suggested Modification to FIGO Stage IV Epithelial Ovarian Cancer
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: International Federation of Gynecology and Obstetrics (FIGO) staging classification for stage IV epithelial ovarian cancer (EOC) separates stages IVA (pleural effusion) and IVB (parenchymal and/or extra-abdominal lymph node metastases).
supporting_text: International Federation of Gynecology and Obstetrics (FIGO) staging classification for stage IV epithelial ovarian cancer (EOC) separates stages IVA (pleural effusion) and IVB (parenchymal and/or extra-abdominal lymph node metastases).
evidence:
- reference: DOI:10.3390/cancers15030706
reference_title: A Suggested Modification to FIGO Stage IV Epithelial Ovarian Cancer
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: International Federation of Gynecology and Obstetrics (FIGO) staging classification for stage IV epithelial ovarian cancer (EOC) separates stages IVA (pleural effusion) and IVB (parenchymal and/or extra-abdominal lymph node metastases).
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.3390/cancers15123095
title: Prevalence of Homologous Recombination Deficiency in First-Line PARP Inhibitor Maintenance Clinical Trials and Further Implication of Personalized Treatment in Ovarian Cancer
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: Prevalence of Homologous Recombination Deficiency in First-Line PARP Inhibitor Maintenance Clinical Trials and Further Implication of Personalized Treatment in Ovarian Cancer
supporting_text: Among ovarian cancer patients with BRCA mutation or homologous recombination deficiency (HRD), the efficacy of Poly-ADP-ribose polymerase (PARP) inhibitors such as olaparib, niraparib, veliparib, and rucaparib has been proven in a number of clinical trials.
evidence:
- reference: DOI:10.3390/cancers15123095
reference_title: Prevalence of Homologous Recombination Deficiency in First-Line PARP Inhibitor Maintenance Clinical Trials and Further Implication of Personalized Treatment in Ovarian Cancer
supports: SUPPORT
evidence_source: COMPUTATIONAL
snippet: Among ovarian cancer patients with BRCA mutation or homologous recombination deficiency (HRD), the efficacy of Poly-ADP-ribose polymerase (PARP) inhibitors such as olaparib, niraparib, veliparib, and rucaparib has been proven in a number of clinical trials.
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
- reference: DOI:10.3390/cancers16081467
title: 'Imaging of Peritoneal Metastases in Ovarian Cancer Using MDCT, MRI, and FDG PET/CT: A Systematic Review and Meta-Analysis'
found_in:
- Metastatic_Ovarian_Cancer-deep-research-falcon.md
findings:
- statement: This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC).
supporting_text: This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC).
evidence:
- reference: DOI:10.3390/cancers16081467
reference_title: 'Imaging of Peritoneal Metastases in Ovarian Cancer Using MDCT, MRI, and FDG PET/CT: A Systematic Review and Meta-Analysis'
supports: SUPPORT
evidence_source: OTHER
snippet: This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC).
explanation: Deep research cited this publication as relevant literature for Metastatic Ovarian Cancer.
This report focuses on advanced/metastatic epithelial ovarian cancer (EOC), including ovarian, fallopian tube, and primary peritoneal carcinomas with advanced-stage dissemination (commonly FIGO III–IV), and particularly metastatic disease corresponding to FIGO stage IV. In contemporary clinical guidance, “advanced EOC” is often used operationally for stage III–IV disease and drives shared diagnostic and treatment pathways. (ghirardi2023diagnosticandtherapeutic pages 1-2, perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
Information here is derived primarily from aggregated disease-level resources and guidelines (e.g., ASCO, SEOM–GEICO; systematic reviews), plus multicenter retrospective cohorts and phase II/III clinical trials in advanced/metastatic settings. (ghirardi2023diagnosticandtherapeutic pages 1-2, ghirardi2023diagnosticandtherapeutic pages 5-7, perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
Ovarian cancer is a leading cause of gynecologic cancer mortality and most patients present at advanced stage. In a diagnostic/treatment pathway review focused on advanced ovarian cancer with peritoneal metastases, the authors state: “Over two thirds of ovarian cancer patients present with advanced stage disease” and standard treatment includes cytoreductive surgery plus carboplatin–paclitaxel chemotherapy. (ghirardi2023diagnosticandtherapeutic pages 1-2)
Inherited DNA repair defects are a major causal contributor to a clinically actionable subset of EOC. Open Targets disease–gene associations for ovarian cancer highlight DNA repair genes and other cancer genes, including BRCA1, BRCA2, RAD51C, RAD51D, BRIP1, PALB2, MSH2, MSH6, and TP53. (OpenTargets Search: metastatic ovarian cancer,ovarian carcinoma)
A contemporary clinical review summarizing risk and prevention reports: “Approximately one-quarter of ovarian cancers are hereditary” and that BRCA1/2 account for a substantial fraction of hereditary cases. (caruso2025ovariancancera pages 3-3)
Quantitative associations reported in a large contemporary review include: * Endometriosis: hazard ratio 4.20 (95% CI 3.59–4.91) in one cited analysis. (caruso2025ovariancancera pages 3-3) * Infertility: standardized incidence ratio 2.0 (95% CI 1.8–4.0). (caruso2025ovariancancera pages 3-3) * Postmenopausal estrogen therapy: relative risk 1.31 (95% CI 1.21–1.41). (caruso2025ovariancancera pages 3-3) * Familial/genetic risk: BRCA carrier lifetime ovarian cancer risk estimated broadly as 20%–70% in one clinical synthesis. (caruso2025ovariancancera pages 3-3)
A clinical risk assessment review provides genotype-stratified absolute lifetime risks: * BRCA1: 39%–58%; BRCA2: 13%–29%. (days2025ovariancancerrisk pages 2-4)
Protective reproductive/hormonal factors with quantitative effect estimates include: * Multiparity: OR per additional birth 0.81 (95% CI 0.75–0.85). (caruso2025ovariancancera pages 3-3) * Breastfeeding: OR 0.72 (95% CI 0.68–0.76). (caruso2025ovariancancera pages 3-3) * Oral contraceptive use: OR 0.66 (95% CI 0.52–0.83). (caruso2025ovariancancera pages 3-3)
A global epidemiology review quantifies similar protective associations: * Ever vs never oral contraceptives: OR 0.73 (95% CI 0.70–0.76); each 5 years of use associated with ~20% lower risk (95% CI 18–23%). (li2026globalepidemiologyof pages 5-7) * Breastfeeding: ~10% lower risk per 12 months (RR 0.89, 95% CI 0.84–0.94). (li2026globalepidemiologyof pages 5-7)
Robust, clinically used gene–environment interaction models specific to metastatic presentation were not identifiable from the retrieved evidence; however, available clinical syntheses emphasize that inherited BRCA-associated risk intersects with reproductive/hormonal exposures (e.g., oral contraceptives) relevant to prevention decisions. (days2025ovariancancerrisk pages 2-4, caruso2025ovariancancera pages 3-3)
Advanced EOC frequently presents with extensive intraperitoneal tumor burden and/or pleural involvement, driving symptoms such as abdominal distension and respiratory symptoms. A prevention/early-detection implementation review notes that CA-125 is elevated in ~80% of advanced ovarian cancer, reflecting the frequent high tumor burden at advanced presentation. (masouleh2024exploringopportunisticsalpingectomy pages 19-23)
Because the retrieved evidence base emphasizes diagnostic pathways rather than symptom prevalence tables, the following HPO mappings are proposed as standard phenotype representations for advanced/metastatic EOC, without frequency claims: * Ascites — HP:0001541 * Abdominal distension — HP:0003270 * Abdominal pain — HP:0002027 * Pleural effusion — HP:0002202 * Dyspnea — HP:0002094 * Elevated CA-125 — HP:0032943 (as a biomarker abnormality)
Peritoneal dissemination is repeatedly highlighted as clinically consequential because it complicates resectability and contributes to morbidity and recurrence risk; peritoneal metastasis mapping is positioned as crucial for planning therapy and predicting feasibility of complete cytoreduction. (tsili2024imagingofperitoneal pages 1-2)
Key clinically actionable molecular concepts for metastatic/advanced EOC include: * BRCA1/BRCA2 alterations (germline and somatic) and broader homologous recombination deficiency (HRD), which predict benefit from PARP inhibitors. (ghirardi2023diagnosticandtherapeutic pages 7-8, caruso2025ovariancancera pages 3-3) * TP53 alterations: a hallmark of high-grade serous ovarian cancer (frequently referenced in epidemiology and molecular summaries and in Open Targets associations), though not typically used alone to select current approved therapies. (OpenTargets Search: metastatic ovarian cancer,ovarian carcinoma, masouleh2024exploringopportunisticsalpingectomy pages 19-23) * FRα (FOLR1) expression: predictive biomarker for mirvetuximab soravtansine benefit in platinum-resistant disease; MIRASOL required ≥75% of cells with ≥2+ staining intensity. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
The SEOM–GEICO 2023 guideline summary emphasizes that new predictive biomarkers enable selection for targeted agents, and that diagnostics should enable biomarker analysis (adequate tissue sampling, cytology for effusions/ascites when present, and molecular profiling). (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
A metastasis-relevant mechanistic chain supported directly by the retrieved evidence is: 1) Primary tubo-ovarian/peritoneal carcinoma develops and sheds tumor into peritoneal cavity → 2) Peritoneal metastases become the predominant spread pattern at diagnosis/recurrence → 3) Peritoneal tumor distribution determines feasibility of complete cytoreduction and drives selection between PDS and NACT-IDS → 4) Residual disease after surgery strongly predicts outcomes. (ghirardi2023diagnosticandtherapeutic pages 1-2, tsili2024imagingofperitoneal pages 1-2)
Ontology suggestions (mechanism mapping): * GO biological processes (suggested): epithelial cell proliferation (GO:0050673), cell adhesion (GO:0007155), extracellular matrix organization (GO:0030198), angiogenesis (GO:0001525), DNA repair (GO:0006281). * CL cell types (suggested): epithelial cell (CL:0000066), fibroblast (CL:0000057), macrophage (CL:0000235), mesothelial cell (CL:0000077).
Peritoneal spread involves structures of the peritoneal cavity and abdominopelvic regions. Imaging meta-analysis emphasizes mapping peritoneal disease extent for surgical planning. (tsili2024imagingofperitoneal pages 1-2)
Stage IV subclassification highlights thoracic involvement: * A multicenter stage IV cohort described FIGO IVA vs IVB outcomes, consistent with pleural involvement defining a distinct stage IV group (IVA) with worse prognosis than IVB in that dataset. (metairie2023asuggestedmodification pages 11-12)
UBERON term suggestions: * Ovary — UBERON:0000992 * Fallopian tube — UBERON:0003889 * Peritoneum — UBERON:0002358 * Greater omentum — UBERON:0003688 * Pleural cavity/pleura — UBERON:0000175 / UBERON:0002097
Advanced EOC typically presents after an insidious course; in one implementation-focused prevention review, the authors emphasize that early symptoms can be vague and that disease may progress rapidly, contributing to late-stage diagnosis. (masouleh2024exploringopportunisticsalpingectomy pages 19-23)
US burden (2024): an imaging systematic review reports that in the United States ~19,680 cases and 12,740 deaths were expected in 2024, and cites an overall 5-year relative survival ~48% for ovarian cancer. (tsili2024imagingofperitoneal pages 1-2)
Global burden and trends (2022–2021): * A contemporary review reports ~324,398 new cases and 206,839 deaths globally (2022). (caruso2025ovariancancera pages 2-3) * Global age-standardized incidence decreased from 7.22 to 6.71 per 100,000 (1990–2021); global mortality decreased from 4.73 to 4.06 per 100,000 (1999–2021). (li2026globalepidemiologyof pages 1-2)
Risk is substantially elevated in hereditary cancer syndromes (e.g., BRCA1/2). Clinical risk review notes that 10%–15% of ovarian cancers have a germline BRCA mutation and provides BRCA1/2 lifetime risk ranges. (days2025ovariancancerrisk pages 2-4)
The diagnostic process in advanced disease is designed to (i) confirm malignancy and histotype, (ii) stage and map disease, and (iii) determine likelihood of complete cytoreduction.
ASCO guideline update (published 2025-03-??; DOI available) explicitly recommends that patients with suspected stage III–IV disease be evaluated by a gynecologic oncologist and that evaluation includes CA-125, CT abdomen/pelvis, and chest imaging, and that all patients be offered germline genetic and somatic testing at diagnosis. In addition, ASCO specifies histologic confirmation before starting NACT and recommends a platinum–taxane doublet for NACT. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
SEOM–GEICO 2023 guideline (published 2024-07; https://doi.org/10.1007/s12094-024-03531-3) emphasizes: * Physical examination and labs including CA-125, plus pelvic ultrasound. * CT chest/abdomen/pelvis for disease extent; MRI and PET-CT as adjuncts in advanced disease. * Initial laparoscopy to obtain histopathology and evaluate feasibility of complete cytoreduction; use of peritoneal extension scoring (e.g., PCI, Fagotti score) for surgical planning. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
A 2024 systematic review/meta-analysis (33 studies; 487 women) concludes MRI and FDG PET/CT have higher per-patient sensitivity than MDCT for detecting peritoneal metastases, and reiterates the clinical importance of mapping peritoneal disease distribution. (tsili2024imagingofperitoneal pages 1-2)
In a pathway review, the authors note that CT and CA-125 have limitations for predicting optimal cytoreduction, whereas laparoscopic assessment using validated scoring provides the highest specificity for identifying patients likely to undergo suboptimal cytoreduction and thus best suited to NACT-IDS. (ghirardi2023diagnosticandtherapeutic pages 1-2)
While not standard-of-care for primary diagnosis in advanced EOC in the retrieved guideline excerpts, evolving studies suggest ctDNA/cfDNA may correlate with CA-125 and potentially identify recurrence earlier than CT/CA-125 changes in small cohorts; however, broad clinical implementation remains investigational. (tsili2024imagingofperitoneal pages 1-2)
Standard first-line management consists of cytoreductive surgery (with the goal of no gross residual disease) plus carboplatin–paclitaxel chemotherapy. (ghirardi2023diagnosticandtherapeutic pages 1-2, ghirardi2023diagnosticandtherapeutic pages 7-8)
Randomized evidence summarized for advanced disease includes: * EORTC-55971: median OS 29 vs 30 months (PDS vs NACT-IDS). (ghirardi2023diagnosticandtherapeutic pages 5-7) * CHORUS: median OS 22.8 vs 24.5 months (PDS vs NACT-IDS). (ghirardi2023diagnosticandtherapeutic pages 5-7) * Pooled analysis (FIGO stage IV subgroup): median OS 21.2 vs 24.3 months and median PFS 9.7 vs 10.6 months, favoring NACT-IDS in that analysis. (ghirardi2023diagnosticandtherapeutic pages 5-7)
A review excerpt summarizes two major phase 3 trials: * GOG-0218: bevacizumab strategy PFS 14.1 vs 10.3 months. * ICON7: PFS 24.1 vs 22.4 months. These results support modest PFS improvements when bevacizumab is added to chemotherapy and continued as maintenance in selected advanced settings. (caruso2025ovariancancera pages 8-8)
In a pathway review, SOLO-1 is summarized as showing HR 0.30 (95% CI 0.23–0.41) for progression/death with olaparib maintenance, and median PFS not reached vs 13.8 months at 41-month follow-up in that trial context. (ghirardi2023diagnosticandtherapeutic pages 7-8)
SORAYA (phase II; JCO 2023-05; https://doi.org/10.1200/JCO.22.01900) abstract states: * ORR 32.4% (95% CI 23.6–42.2); median duration of response 6.9 months. * Common adverse events included blurred vision (41%) and keratopathy (29%). (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
MIRASOL (phase 3; NEJM 2023-12; https://doi.org/10.1056/NEJMoa2309169) abstract states: * Median PFS 5.62 vs 3.98 months; ORR 42.3% vs 15.9%. * Median OS 16.46 vs 12.75 months. * Grade ≥3 adverse events 41.7% vs 54.1%. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
A 2024 update on SORAYA reports final median OS 15.0 months (95% CI 11.5–18.7) at data cut-off 2022-12-22, supporting clinically meaningful activity in FRα-high platinum-resistant disease. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
A multicenter retrospective study of FIGO stage IV epithelial ovarian cancer (n=307) reported worse outcomes for stage IVA vs IVB: * Median OS 31 vs 45 months and median PFS 18 vs 25 months (IVA vs IVB), suggesting meaningful prognostic heterogeneity within stage IV and supporting efforts to refine stage IV subclassification. (metairie2023asuggestedmodification pages 11-12)
Disease mapping and completeness of cytoreduction are repeatedly emphasized as prognostically critical; the pathway review notes that achieving no gross residual disease is the surgical goal and that residual disease volume strongly predicts survival. (ghirardi2023diagnosticandtherapeutic pages 1-2, ghirardi2023diagnosticandtherapeutic pages 5-7)
A clinical review reports that bilateral salpingo-oophorectomy is the most effective preventive option for high-risk women; a pooled analysis of 9,192 BRCA1/2 carriers found an 81% risk reduction over 4 years (HR 0.19, 95% CI 0.13–0.27). (caruso2025ovariancancera pages 3-3)
A global epidemiology review reports unilateral or bilateral salpingectomy associated with reduced ovarian cancer risk (HR 0.65, 95% CI 0.52–0.81). (li2026globalepidemiologyof pages 5-7)
A feasibility/safety synthesis of opportunistic salpingectomy in general surgery settings suggests relative safety in limited data (no complications attributable to the procedure in 140 patients across included studies) and reports feasibility in selected procedures (e.g., successful in 98/105 cholecystectomies in one study). (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
A prevention/implementation review reports that large screening trials have not demonstrated clear mortality benefit: * PLCO (78,286 women): CA-125 + transvaginal ultrasound had PPV 26.5% and no survival benefit at 15 years. * UKCTOCS: no significant survival improvement. (masouleh2024exploringopportunisticsalpingectomy pages 19-23)
Direct evidence on specific ovarian cancer animal models and organoid/PDX systems was not extracted into the citable evidence set for this report. As a result, this section is not populated with model-specific performance claims.
1) Imaging evidence base update (2024): systematic review/meta-analysis supports MRI and FDG PET/CT as preferred modalities (vs MDCT) for detecting peritoneal metastases in ovarian cancer, emphasizing the need for disease mapping to guide surgery. (tsili2024imagingofperitoneal pages 1-2) 2) Guideline-driven diagnostic pathway emphasis (2024): SEOM–GEICO (2023 guideline published 2024) highlights structured workup including CA-125, CT chest/abdomen/pelvis, and the increasing role of laparoscopy-based scoring and biomarker-informed therapy selection. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2) 3) Targeted therapy implementation: mirvetuximab soravtansine demonstrates clinically meaningful benefit in FRα-high platinum-resistant ovarian cancer (SORAYA 2023; MIRASOL 2023), supporting routine FRα testing in this setting. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
A diagnostic/therapeutic pathway algorithm figure (Figure 1) from a 2023 review illustrates how clinical assessment, biopsy confirmation, and laparoscopic scoring guide selection between PDS and NACT-IDS in advanced disease. (ghirardi2023diagnosticandtherapeutic media b74131ac)
| Domain | Summary | Key sources |
|---|---|---|
| Disease definition, identifiers, synonyms | Advanced/metastatic epithelial ovarian cancer refers to epithelial ovarian, fallopian tube, or primary peritoneal carcinoma presenting with disseminated intra-abdominal disease and/or distant metastasis; advanced disease is commonly stage III–IV, and metastatic disease generally corresponds to FIGO stage IV. Common synonyms used in the literature include advanced ovarian cancer, stage IV epithelial ovarian cancer, metastatic ovarian cancer, ovarian cancer with peritoneal metastases, and advanced epithelial ovarian cancer. Disease-level aggregated resources/tools referenced include Open Targets association data for ovarian cancer (MONDO_0008170). MeSH/ICD-10 identifiers are variably applied in practice to ovarian malignancy rather than a unique metastatic subtype; ICD-10 commonly maps ovarian cancer to C56. | Open Targets context (ovarian cancer MONDO_0008170); Ghirardi 2023 https://doi.org/10.3390/cancers15020407; Métairie 2023 https://doi.org/10.3390/cancers15030706 |
| Key clinical characteristics and spread pattern | Peritoneal metastases are the most common route of spread at diagnosis and recurrence. FIGO stage IVA denotes pleural effusion/pleural involvement; stage IVB denotes parenchymal metastases and/or extra-abdominal lymph node metastases. In one multicenter stage IV cohort (n=307), median OS was 31 months for stage IVA versus 45 months for stage IVB; median PFS 18 versus 25 months. | Tsili 2024 https://doi.org/10.3390/cancers16081467; Métairie 2023 https://doi.org/10.3390/cancers15030706 |
| Diagnostic workup | Guideline-level workup includes gynecologic oncologist assessment, CA-125, CT abdomen/pelvis plus chest imaging, and germline and somatic testing at diagnosis. Cross-sectional imaging maps disease burden and unresectable sites. MRI and FDG PET/CT showed higher per-patient sensitivity than MDCT in a meta-analysis (33 studies, 487 women); MRI vs MDCT p=0.03, PET/CT vs MDCT p<0.01; MRI vs PET/CT p=0.84. Histologic confirmation is recommended before neoadjuvant chemotherapy. Diagnostic laparoscopy with Fagotti/laparoscopic predictive index assessment is highlighted as the most specific approach to identify patients unlikely to achieve optimal cytoreduction. The Peritoneal Cancer Index (PCI; 13 abdominopelvic regions) quantifies tumor burden and has prognostic value. CA-125 is useful but limited alone for predicting resectability. | ASCO update 2025 https://doi.org/10.1200/jco-24-02589; Perez-Fidalgo 2024 https://doi.org/10.1007/s12094-024-03531-3; Tsili 2024 https://doi.org/10.3390/cancers16081467; Ghirardi 2023 https://doi.org/10.3390/cancers15020407; Rizzo 2025 https://doi.org/10.1007/s00330-024-11300-7 |
| Molecular biomarkers and clinical use | BRCA1/2: predictive for platinum/PARP inhibitor benefit; maintenance selection. HRD: central biomarker for PARP inhibitor maintenance; prevalence varies across trials and assays; clinically relevant in first-line maintenance selection. TP53: near-ubiquitous hallmark of high-grade serous disease and useful as a molecular disease-defining feature rather than a routine therapy-selection biomarker. FRα: biomarker for mirvetuximab eligibility in platinum-resistant disease; MIRASOL required ≥75% of cells with ≥2+ staining intensity, and SORAYA enrolled FRα-high tumors. Open Targets disease associations prominently include BRCA1, BRCA2, RAD51C, TP53, RAD51D, BRIP1, PALB2, MSH2, and MSH6. | Paik 2023 https://doi.org/10.3390/cancers15123095; Moore 2023 https://doi.org/10.1056/NEJMoa2309169; Matulonis 2023 https://doi.org/10.1200/jco.22.01900; Open Targets context |
| Standard first-line treatment backbone | Standard treatment combines cytoreductive surgery and platinum-taxane chemotherapy. Typical first-line regimen is carboplatin plus paclitaxel every 3 weeks for 6 cycles. Goal of surgery is no gross residual disease. | Ghirardi 2023 https://doi.org/10.3390/cancers15020407; Caruso 2025 review excerpt |
| Primary debulking surgery (PDS) vs neoadjuvant chemotherapy (NACT-IDS) | PDS is preferred when complete or near-complete cytoreduction is feasible with acceptable morbidity; NACT followed by interval debulking is favored when complete upfront cytoreduction is unlikely or perioperative risk is high. EORTC-55971 (670 patients): median OS 29 vs 30 months (PDS vs NACT-IDS). CHORUS (550 patients): median OS 22.8 vs 24.5 months. Pooled analysis in FIGO stage IV: median OS 21.2 vs 24.3 months and median PFS 9.7 vs 10.6 months, favoring NACT-IDS. SCORPION (171 patients): median PFS 15 vs 14 months and median OS 41 vs 43 months, with less morbidity for NACT-IDS. | Ghirardi 2023 https://doi.org/10.3390/cancers15020407; ASCO update 2025 https://doi.org/10.1200/jco-24-02589 |
| HIPEC | In selected stage III patients treated with NACT/interval surgery, HIPEC may be offered in experienced centers. Randomized data cited in review: cisplatin 100 mg/m2 at IDS improved PFS 14.2 vs 10.7 months and OS 45.7 vs 33.9 months; meta-analysis HR 0.585 for PFS and HR 0.519 for OS. | Ghirardi 2023 https://doi.org/10.3390/cancers15020407; ASCO update 2025 https://doi.org/10.1200/jco-24-02589 |
| Bevacizumab | Added to chemotherapy then continued as maintenance, bevacizumab prolonged PFS in major first-line trials: GOG-0218 14.1 vs 10.3 months; ICON7 24.1 vs 22.4 months. In a high-risk subgroup, ICON7 OS was 39.3 vs 34.5 months (HR 0.78). | Caruso 2025 review excerpt; Ghirardi 2023 https://doi.org/10.3390/cancers15020407 |
| PARP inhibitor maintenance | PARP inhibitors are central maintenance options after response to first-line platinum, particularly in BRCA-mutated/HRD-positive disease. SOLO-1: olaparib reduced risk of progression/death by 70% (HR 0.30, 95% CI 0.23–0.41); median PFS not reached vs 13.8 months at 41-month follow-up. Seven-year SOLO-1 OS data reported in review excerpt: 67.0% vs 46.5%; median OS not reached vs 75.2 months; HR 0.55 (95% CI 0.40–0.76). | Ghirardi 2023 https://doi.org/10.3390/cancers15020407; Caruso 2025 review excerpt; Paik 2023 https://doi.org/10.3390/cancers15123095 |
| Mirvetuximab soravtansine: SORAYA | Biomarker-selected option for FRα-high platinum-resistant ovarian cancer after prior bevacizumab. SORAYA enrolled 106 patients; 105 efficacy-evaluable; 51% had 3 prior lines; 48% prior PARP inhibitor. ORR 32.4% (95% CI 23.6–42.2), including 5 complete and 29 partial responses; median duration of response 6.9 months (95% CI 5.6–9.7); final median OS 15.0 months (95% CI 11.5–18.7). Common treatment-related adverse events: blurred vision 41% (grade 3–4: 6%), keratopathy 29% (grade 3–4: 9%), nausea 29% (grade 3–4: 0%). | Matulonis 2023 https://doi.org/10.1200/jco.22.01900; Coleman 2024 https://doi.org/10.1136/ijgc-2024-005401 |
| Mirvetuximab soravtansine: MIRASOL | Phase 3 confirmatory trial in FRα-positive platinum-resistant high-grade serous ovarian cancer (453 randomized; 227 MIRV, 226 chemotherapy). Median PFS 5.62 vs 3.98 months; ORR 42.3% vs 15.9%; median OS 16.46 vs 12.75 months; grade ≥3 adverse events 41.7% vs 54.1%; serious adverse events 23.9% vs 32.9%; discontinuations 9.2% vs 15.9%. | Moore 2023 https://doi.org/10.1056/NEJMoa2309169 |
| Prognosis / survival context | Most ovarian cancers present at advanced stage; approximately 75% present advanced and advanced-stage 5-year survival is generally poor. Review excerpts cite overall 5-year survival of roughly 10–40% for advanced-stage disease; stage-specific SEER-derived figures in one study were 17% 5-year relative survival for stage IV. High PCI predicts worse survival with pooled HR 2.79 for OS and 1.89 for PFS in advanced disease. | Ghirardi 2023 https://doi.org/10.3390/cancers15020407; Zhang 2024 https://doi.org/10.1186/s12905-024-03199-5; Wang 2024 https://doi.org/10.3389/fonc.2024.1421828; Caruso 2025 review excerpt |
Table: This table condenses identifiers, staging, diagnostic workup, biomarkers, and major treatment trial metrics for metastatic/advanced epithelial ovarian cancer. It is designed as a quick-reference artifact for knowledge base population and narrative synthesis.
References
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