Treating ovarian epithelial cancer requires a comprehensive approach tailored to each patient’s unique situation, combining surgery with powerful drug therapies to target cancer cells throughout the body.

How Treatment Approaches Aim to Control Ovarian Epithelial Cancer

When someone receives a diagnosis of ovarian epithelial cancer, the primary goal of treatment is to remove as much of the disease as possible and prevent it from returning or spreading further. This type of cancer, which develops in the thin layer of tissue covering the ovaries, often spreads into the abdomen before it causes noticeable symptoms. Because of this tendency to advance before detection, treatment must address both visible tumors and microscopic cancer cells that may have traveled to other areas.^[1]

Treatment decisions depend on several important factors. The stage of the cancer—meaning how far it has spread from the ovaries—plays a crucial role in determining which therapies will be most effective. The grade of the cancer, which describes how abnormal the cells look under a microscope, also influences treatment choices. Higher-grade cancers tend to grow more quickly and may require more aggressive treatment approaches. Additionally, the specific subtype of epithelial cancer matters, because some varieties respond better to certain drugs than others.^[4]

Modern medicine offers both standard treatments that have been thoroughly tested and proven effective, as well as newer experimental therapies being studied in clinical trials. For many patients, the journey involves an initial intensive treatment phase followed by maintenance therapy designed to keep the cancer under control for as long as possible. Throughout this process, doctors work to balance effectiveness with quality of life, adjusting treatments based on how well the cancer responds and how the patient tolerates the therapies.^[3]

Standard Treatment Approaches for Ovarian Epithelial Cancer

The cornerstone of treating ovarian epithelial cancer combines two main approaches: surgical removal of tumors and chemotherapy to eliminate remaining cancer cells. This combination has been the standard of care for decades and continues to form the foundation of treatment for most patients diagnosed with this disease.^[10]

Surgery: Removing Visible Cancer

Surgery serves as the first major step in treatment for most patients with ovarian epithelial cancer. The surgical approach, called debulking or cytoreductive surgery, aims to remove as much visible tumor as possible. During this procedure, surgeons typically remove both ovaries and fallopian tubes in an operation called bilateral salpingo-oophorectomy. They also usually remove the uterus in a procedure known as hysterectomy. Beyond these organs, surgeons examine the entire abdominal cavity and remove any visible cancer deposits from the peritoneum, the thin lining that covers abdominal organs.^[6]

In some cases, the surgery may also involve removing the omentum, a large fatty tissue that hangs down from the stomach and can harbor cancer cells. Surgeons may also take samples from lymph nodes to check whether cancer has spread to these structures. The goal of debulking surgery is to leave behind no visible tumor, or at most very small amounts of disease. Research has consistently shown that patients whose surgery leaves behind less tumor tissue tend to have better outcomes and longer survival.^[1]

For some patients diagnosed with early-stage disease that appears confined to the ovaries, surgery alone may be sufficient. However, most patients will need additional treatment with chemotherapy even after successful surgery, because microscopic cancer cells may remain in the body even when all visible tumors have been removed.^[11]

Chemotherapy: The Foundation of Drug Treatment

Following surgery, or sometimes before surgery to shrink large tumors, patients receive chemotherapy. The standard chemotherapy regimen for ovarian epithelial cancer combines two types of drugs: a platinum-based drug (usually carboplatin) and a taxane drug (usually paclitaxel). This combination has been extensively studied and provides the best balance of effectiveness and tolerability for most patients.^[13]

Carboplatin works by damaging the DNA inside cancer cells, preventing them from dividing and eventually causing them to die. Paclitaxel, derived originally from the Pacific yew tree, interferes with the internal structure of cells, making it impossible for them to divide properly. When used together, these drugs attack cancer cells through different mechanisms, making the treatment more effective than either drug alone would be.^[3]

The typical treatment course involves receiving these drugs through an intravenous line every three weeks, for a total of six treatment cycles. This means the entire chemotherapy phase usually lasts about four and a half months. Each treatment session takes several hours, as the drugs are infused slowly to minimize side effects. Many patients can receive their chemotherapy in an outpatient clinic and return home the same day.^[11]

Intraperitoneal Chemotherapy

For some patients with advanced disease, doctors may recommend delivering chemotherapy directly into the abdominal cavity rather than only through a vein. This approach, called intraperitoneal chemotherapy, allows very high concentrations of drugs to reach cancer cells in the abdomen while limiting exposure of the rest of the body to these powerful medications. A special catheter is placed in the abdomen during surgery, and chemotherapy drugs are infused directly into this space during treatment cycles.^[13]

Research has suggested that intraperitoneal chemotherapy may improve survival for some patients compared to standard intravenous chemotherapy alone. However, this approach causes more side effects and complications, including abdominal pain, infections related to the catheter, and difficulties with the catheter functioning properly. Because of these challenges, intraperitoneal chemotherapy has not been universally adopted and is typically reserved for selected patients with advanced disease who have undergone successful debulking surgery.^[13]

Side Effects of Standard Treatment

Both surgery and chemotherapy can cause significant side effects that affect patients’ quality of life during treatment. Surgical complications may include bleeding, infection, blood clots in the legs or lungs, and damage to nearby organs such as the bowel or bladder. Recovery from major abdominal surgery typically takes several weeks, and some patients experience long-term effects such as bowel changes or scarring inside the abdomen.^[6]

Chemotherapy side effects vary from person to person but commonly include fatigue, nausea and vomiting, hair loss, and increased risk of infections due to low white blood cell counts. Carboplatin can damage the kidneys and reduce blood cell production in the bone marrow. Paclitaxel frequently causes neuropathy, a type of nerve damage that leads to numbness, tingling, or pain in the hands and feet. This nerve damage can be long-lasting and may not fully resolve after treatment ends.^[11]

Other chemotherapy side effects may include mouth sores, diarrhea or constipation, loss of appetite, and changes in taste and smell. Many of these effects are temporary and improve after treatment is completed, but some can persist for months or years. Doctors can prescribe medications to help manage nausea, prevent infections, and address other specific problems that arise during treatment.^[1]

Treatment in Clinical Trials: Innovative Approaches

While standard chemotherapy remains effective for many patients, researchers have been developing and testing new therapies that target specific weaknesses in cancer cells or harness the body’s immune system to fight the disease. These newer treatments are being evaluated in clinical trials, which are carefully designed research studies that test whether new therapies are safe and effective.^[12]

Targeted Antibodies: Precision Weapons Against Cancer

One of the most successful new treatment categories involves drugs called monoclonal antibodies, which are engineered proteins designed to attach to specific targets on cancer cells or in the tumor environment. These drugs work differently than traditional chemotherapy, which attacks all rapidly dividing cells. Instead, targeted antibodies home in on particular molecules that cancer cells need to survive and grow.^[16]

Bevacizumab (known by the brand name Avastin) represents one major advance in this area. This drug targets a protein called VEGF (vascular endothelial growth factor), which cancer cells produce to stimulate the growth of new blood vessels. Tumors need these blood vessels to bring in oxygen and nutrients, so by blocking VEGF, bevacizumab essentially starves the tumor. The drug has been approved for use in combination with chemotherapy for patients with newly diagnosed advanced ovarian cancer and for those whose cancer has returned.^[12]

Clinical trials have shown that adding bevacizumab to chemotherapy can delay cancer progression by several months compared to chemotherapy alone. However, the drug does cause side effects, including high blood pressure, bleeding problems, and in rare cases, dangerous perforation of the intestine. Patients receiving bevacizumab require careful monitoring throughout treatment.^[16]

Another innovative antibody drug is mirvetuximab soravtansine, marketed as Elahere. This drug represents a new class called antibody-drug conjugates, which combine a targeting antibody with a chemotherapy payload. The antibody part attaches to a protein called folate receptor alpha, which is found in high amounts on many ovarian cancer cells but not on most normal cells. Once attached, the drug delivers its toxic chemotherapy cargo directly into the cancer cell.^[12]

This targeted delivery system allows for much more precise cancer cell killing while sparing healthy tissues. Clinical trials have shown that mirvetuximab soravtansine can shrink tumors in patients whose cancer has returned after multiple prior treatments, with response rates approximately double those seen with other available therapies. The drug has been approved specifically for patients with advanced ovarian cancer that has high levels of folate receptor alpha and has progressed after previous treatments.^[12]

PARP Inhibitors: Exploiting Cancer’s DNA Repair Weaknesses

PARP inhibitors represent another major breakthrough in ovarian cancer treatment. These drugs block an enzyme called poly (ADP-ribose) polymerase, which helps cells repair damaged DNA. When PARP is blocked, cancer cells with existing DNA repair defects become unable to fix their genetic damage and eventually die. This approach works particularly well in cancers with mutations in the BRCA1 or BRCA2 genes, which are already deficient in DNA repair.^[12]

Several PARP inhibitors have been approved for ovarian cancer treatment, including olaparib, niraparib, and rucaparib. These drugs are used as maintenance therapy, meaning patients take them continuously after completing initial chemotherapy to prevent or delay cancer recurrence. Clinical trials have demonstrated that PARP inhibitors can significantly extend the time before cancer returns, especially in patients with BRCA mutations or other DNA repair deficiencies.^[16]

Patients typically take PARP inhibitors as pills at home rather than receiving them through infusions at a clinic. Common side effects include fatigue, nausea, anemia (low red blood cell counts), and low platelet counts that can increase bleeding risk. Most side effects can be managed by adjusting the dose or temporarily stopping the medication. Long-term use of PARP inhibitors carries a small risk of developing a secondary cancer, particularly a type of blood cancer called myelodysplastic syndrome, though this risk appears to be quite low.^[12]

Immunotherapy: Unleashing the Immune System

Immunotherapy drugs work by helping the patient’s own immune system recognize and attack cancer cells. One important category of immunotherapy drugs is called checkpoint inhibitors, which block proteins that cancer cells use to hide from immune surveillance. By blocking these protective signals, checkpoint inhibitors allow immune cells to identify and destroy cancer cells.^[16]

Two checkpoint inhibitors, pembrolizumab (Keytruda) and dostarlimab (Jemperli), have been approved for subsets of patients with advanced ovarian cancer. These drugs specifically target the PD-1/PD-L1 pathway, which cancer cells exploit to avoid immune detection. However, these immunotherapy drugs only work well in patients whose tumors have specific genetic characteristics, particularly microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR). These conditions indicate that the tumor has accumulated many mutations, making it more recognizable to the immune system.^[16]

Unfortunately, only a small percentage of ovarian cancer patients have tumors with these characteristics. Research is ongoing to identify ways to make immunotherapy effective for more patients with ovarian cancer. Scientists are testing combinations of immunotherapy drugs with chemotherapy, targeted therapies, or other immunotherapy agents to boost effectiveness.^[16]

Clinical Trial Phases and Locations

New treatments move through a structured development process before they can be widely used. Phase I trials primarily test safety, determining what doses of a new drug can be given without causing unacceptable side effects. These trials typically involve small numbers of patients who have tried many other treatments without success. Phase II trials expand to larger groups and focus on whether the treatment shows signs of effectiveness against the cancer. Phase III trials compare the new treatment directly against the current standard treatment in large groups of patients, providing definitive evidence about whether the new approach offers real benefits.^[3]

Clinical trials for ovarian cancer are conducted at cancer centers and hospitals throughout the United States, Europe, and around the world. Major academic medical centers and comprehensive cancer centers typically offer the widest range of trial options. Patients interested in participating in a trial can ask their oncologist about available studies or search online databases maintained by organizations such as the National Cancer Institute and ClinicalTrials.gov.^[3]

To participate in a clinical trial, patients must meet specific eligibility criteria, which may include factors such as the stage and type of cancer, previous treatments received, overall health status, and results of certain laboratory tests. Trial participation is voluntary, and patients can withdraw at any time. Clinical trials offer access to promising new treatments before they become widely available, along with close monitoring by expert medical teams.^[8]

Most Common Treatment Methods

• Surgery
  • Bilateral salpingo-oophorectomy removes both ovaries and fallopian tubes
  • Hysterectomy removes the uterus
  • Omentectomy removes the fatty tissue covering abdominal organs
  • Debulking surgery aims to remove all visible tumor tissue
  • Lymph node biopsy checks for cancer spread to lymphatic system
• Chemotherapy
  • Carboplatin and paclitaxel combination given intravenously every three weeks for six cycles
  • Intraperitoneal chemotherapy delivers drugs directly into the abdominal cavity
  • Irinotecan plus cisplatin may be used for clear cell adenocarcinoma subtype
• Targeted Antibody Therapy
  • Bevacizumab blocks VEGF to prevent tumor blood vessel growth
  • Mirvetuximab soravtansine delivers chemotherapy directly to cells with folate receptor alpha
• PARP Inhibitors
  • Olaparib, niraparib, and rucaparib used as maintenance therapy
  • Block DNA repair enzymes, particularly effective in BRCA-mutated cancers
  • Taken as oral pills to delay cancer recurrence after initial treatment
• Immunotherapy
  • Pembrolizumab and dostarlimab block the PD-1/PD-L1 pathway
  • Approved for patients with microsatellite instability-high or mismatch repair deficiency

Treatment for Recurrent Disease

Despite effective initial treatment, ovarian epithelial cancer unfortunately returns in many patients. How doctors approach treatment of recurrent disease depends largely on how much time has passed since the completion of initial chemotherapy. This interval provides important information about how sensitive the cancer remains to platinum-based drugs.^[11]

Patients whose cancer returns six months or more after completing platinum-based chemotherapy are considered to have platinum-sensitive disease. These patients often respond well to retreatment with platinum drugs, either the same combination used initially or a different platinum-based regimen. Many patients with platinum-sensitive recurrence also receive bevacizumab along with chemotherapy, and may continue taking a PARP inhibitor or bevacizumab as maintenance therapy after chemotherapy is completed.^[11]

When cancer returns within six months of completing platinum chemotherapy, it is classified as platinum-resistant disease. These cancers are unlikely to respond well to platinum drugs again, so doctors typically recommend different chemotherapy agents. Options may include drugs such as topotecan, gemcitabine, or pegylated liposomal doxorubicin. While these alternative chemotherapy drugs can provide benefit, response rates tend to be lower than with initial treatment, and the goal often shifts toward controlling symptoms and maintaining quality of life rather than cure.^[11]

For patients whose cancer has returned multiple times and is no longer responding to standard chemotherapy, newer targeted therapies such as mirvetuximab soravtansine may offer additional treatment options. Clinical trials testing experimental drugs and treatment combinations also provide important opportunities for patients with heavily pretreated disease.^[12]