In 2025, the field of ovarian cancer prevention and management in China has achieved leapfrog development in clinical research and clinical practice. Key breakthroughs, including the expansion of populations eligible for first-line drug maintenance therapy, the quality upgrade of surgical protocols, and the humanistic optimization of holistic management, have injected strong impetus into improving patient prognosis and enhancing the quality of survival. At the end of the year, Obstetrics and Gynecology Network specially invited Professor Di Wen from Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Based on his team's rich clinical practice and profound academic accumulation in the field, Professor Di systematically sorted out and in-depth interpreted the core advances, management strategies and future trends in the ovarian cancer field throughout the year, providing an authoritative reference for the development of the industry.
01 New Breakthroughs in First-line Drug Maintenance Therapy and Surgical Protocols for Ovarian Cancer in 2025
2025 has witnessed remarkable achievements in the optimization of first-line drug maintenance therapy and surgical protocols for ovarian cancer. First-line maintenance therapy has advanced from "precision screening" to "benefit for all populations".
The FZOCUS-1 study demonstrated that for newly diagnosed patients with advanced ovarian cancer, regardless of BRCA1/2 mutation status, fluzoparib combined with apatinib or fluzoparib monotherapy could prolong progression-free survival (PFS). It also answered the question of the benefit of PARP inhibitor combined with anti-angiogenic drug in a head-to-head manner for the first time: the combination therapy showed a trend of PFS improvement in the homologous recombination proficient (HRP) population, but the overall benefit was not further enhanced.
In terms of combination therapy, the KEYLYNK-001 study presented at the Society of Gynecologic Oncology (SGO) Annual Meeting, the FIRST/ENGOT-OV44 study at the American Society of Clinical Oncology (ASCO) Annual Meeting, and the DUO-O study at the European Society for Medical Oncology (ESMO) Annual Meeting explored the regimens of PD-1/PD-L1 inhibitor combined with chemotherapy and PARP inhibitor, respectively. Although PFS was prolonged in some populations (e.g., BRCA wild-type and homologous recombination deficiency (HRD)-positive subgroups), none of these regimens translated into a significant overall survival (OS) benefit. Considering comprehensively safety, economic efficiency and convenience, PARP inhibitor monotherapy remains the first choice for first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer.
In terms of surgical protocols, the focus is on the re-evaluation of the value of high-quality primary debulking surgery (PDS). The TRUST study published at the ASCO Annual Meeting confirmed in high-quality gynecologic oncology centers with ≥36 initial PDS procedures per year and an R0 resection rate of ≥50% that initial PDS significantly improved patient PFS compared with neoadjuvant chemotherapy plus interval debulking surgery (NACT-IDS) (22.1 months vs 19.7 months, HR=0.80). The benefit was more pronounced especially in FIGO stage III patients (HR=0.73) and patients with R0 resection (HR=0.69). This study provides high-level evidence for the controversy over "when to perform surgery" for advanced ovarian cancer, highlights the value of high-quality initial PDS, and also emphasizes the necessity of establishing a quality assurance system for gynecologic oncology surgery.
02 Quality of Life and Holistic Management Strategies Against the Background of Prolonged Survival of Ovarian Cancer Patients
At present, the survival time of ovarian cancer patients has been prolonged, but problems such as fear of recurrence and the need for psychological support have become prominent. It is necessary to improve holistic management from multiple dimensions to enhance the quality of life.
First is multidisciplinary collaborative management. A team covering gynecologic oncology, radiology, pathology, radiation oncology, medical oncology, clinical nutrition, and clinical psychology should be established to conduct regular joint consultations, comprehensively assess patients' tumor stage, genetic status, physical function, etc., and formulate personalized regimens. This breaks the limitations of the "one doctor, one patient" and "single specialty for single disease" models, ensuring the precision and safety of treatment.
Second, the parallel implementation of precision therapy and maintenance therapy. Based on genetic testing results (e.g., BRCA mutation status, HRD status), PARP inhibitors, targeted drugs or immunotherapeutic drugs are selected to delay recurrence and prolong patient PFS, while reducing the impact on patients' quality of life and improving it.
Third, the strengthening of nutritional support and rehabilitation guidance. Customized nutritional regimens are formulated for patients to ensure the intake of protein, vitamins and other nutrients, with enteral/parenteral nutrition supplementation when necessary. Moderate exercise (e.g., walking, yoga) is encouraged, and the intensity and frequency are adjusted according to physical conditions to promote functional recovery.
Fourth, the emphasis on psychological support and patient education. Psychological counseling is provided to alleviate patients' anxiety and depression and enhance their confidence in treatment. Regular educational activities are carried out to popularize disease knowledge, treatment regimens and rehabilitation precautions to patients and their families, improving their self-management ability.
Finally, the implementation of regular follow-up and monitoring. Close attention is paid to treatment-related adverse reactions (e.g., chemotherapy-induced nausea and vomiting, gastrointestinal reactions caused by PARP inhibitors, myelosuppression), and symptomatic treatment is given in a timely manner. A standardized follow-up system is established to screen for recurrence and metastasis through regular imaging examinations, tumor marker detection, etc., and treatment and follow-up plans are dynamically adjusted to ensure that patients receive continuous care and support.
03 Prospects for Revolutionary Trends in Ovarian Cancer Treatment
The future of ovarian cancer treatment will witness revolutionary breakthroughs in precision, therapeutic innovation and treatment models, further improving patient prognosis and quality of life.
Precision therapy and personalized medicine will upgrade from "single-gene guidance" to "multi-omics prediction". In addition to BRCA/HRD testing, multi-omics technologies such as whole-genome sequencing and liquid biopsy will conduct a comprehensive analysis of tumor molecular characteristics, and combine with artificial intelligence (AI) algorithms to predict patients' response to different regimens, realizing truly personalized treatment. Among them, the innovation of liquid biopsy technology is of great significance: dynamic monitoring of circulating tumor DNA (ctDNA) can early warn of recurrence risk 4 months in advance, reflect tumor dynamics more accurately, and help evaluate therapeutic efficacy and predict recurrence risk.
Therapeutic innovation focuses on the "synergistic breakthrough" of antibody-drug conjugates (ADCs) combined with immunotherapy. In the field of platinum-resistant recurrent ovarian cancer, ADC drugs targeting folate receptors and other targets have gradually entered clinical practice, which can accurately deliver cytotoxic drugs to tumor cells and reduce systemic toxicity. Their "bystander effect" and "immune activation effect" lay a foundation for the "ADC + immunotherapy" combination strategy. Moreover, ADC drugs are advancing from second-line therapy to first-line therapy and maintenance therapy, marking the entry of ovarian cancer treatment into an era of precision guided by biomarkers.
The treatment model will shift from "intermittent treatment" to "chronic disease-oriented management". The L-MOCA study presented at the ESMO Annual Meeting showed that the median OS of the entire Asian population with platinum-sensitive relapsed (PSR) ovarian cancer reached 51 months, providing support for the "chronic disease-oriented management" of ovarian cancer. In the future, maintenance therapy strategies will shift from "precision" selection relying on BRCA/HRD status to more extensive "stratified" optimization, realizing "access for all populations". At the same time, personalized monitoring will ensure the safety of long-term treatment with PARP inhibitors, help patients establish confidence in long-term treatment, realize the long-termization of maintenance therapy, and ultimately achieve the goal of "living longer and living better".
In 2025, the field of ovarian cancer has achieved phased results in treatment protocols and holistic management. The development of multi-omics technologies, new combination therapies and chronic disease-oriented management models will continue to drive the field towards greater precision, higher efficiency and more humanistic care, bringing more hope for survival to patients.
Expert Profile
Professor Di WenRenji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
Chief Physician, Professor, Doctoral Supervisor, Director of the Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
President of the Gynecologists and Obstetricians Branch of the Chinese Medical Doctor Association
Vice Chairman of the Gynecologic and Obstetric Branch of the Chinese Medical Association
President of the Gynecologists and Obstetricians Branch of the Shanghai Medical Doctor Association
Director of the Shanghai Maternal and Infant Safety Expert Committee
Associate Editor-in-Chief of Chinese Journal of Obstetrics and Gynecology, Associate Editor of Chinese Journal of Practical Gynecology and Obstetrics and Shanghai Medical Journal, as well as Editorial Board Member of multiple other journals
Chief Editor of multiple textbooks including Obstetrics and Gynecology (4th Edition for 8-year program), the National Health Commission's Standardized Training Textbook for Resident Physicians Obstetrics and Gynecology, and the National Health and Family Planning Commission's English Standardized Textbook Obstetrics and Gynecology
As the first completed person, he has won the Second Prize of Science and Technology Progress of the Ministry of Education (2010), Second Prize of the Chinese Medical Science and Technology Award (2022), First Prize of the Shanghai Science and Technology Award (2022), First Prize of the Shanghai Medical Science and Technology Award (2018), Second Prize of the Shanghai Medical Award (2009) and Third Prize of Shanghai Science and Technology Progress (2009).
The textbooks compiled by him have won the Special Prize of Excellent Teaching Materials of the 12th Session of Shanghai Jiao Tong University (2009), Second Prize of Excellent Teaching Materials for Shanghai Colleges and Universities (2011) and Award for Excellent Teaching Materials of Shanghai General Colleges and Universities (2015).
He was selected into the Shanghai Science and Technology Commission's Excellent Academic Leader Training Program (2008) and awarded the title of Shanghai Leading Talent (2011).
He won the honorary title of National Good Doctor by the Central Civilization Office and the National Health Commission (2019), and the Fok Ying Tung Award for World Outstanding Chinese Physicians by the World Federation of Chinese Medical Doctors (2023).
Responsible Editor: Lily