Epithelial Ovarian Cancer Care in the Era of Precision Medicine

Ovarian cancer remains the deadliest gynecologic malignancy, with 5-year survival rates below 40%.¹ Although outcomes continue to depend heavily on stage at diagnosis, the management of its most common subtype, epithelial ovarian cancer (EOC), is increasingly shaped by tumor biology rather than anatomy alone, particularly in high-grade serous ovarian carcinoma.^1-3

Ovarian, fallopian tube, and primary peritoneal cancers share common diagnostic and therapeutic pathways, demanding continuity across diagnosis, treatment, recurrence, and survivorship.^1-3 Given recurrence rates approaching 80% and frequent progression to platinum-resistant disease, EOC is more accurately characterized as a chronic, relapsing illness than an episodic malignancy, necessitating anticipatory, longitudinal care coordination.¹ This reframing fundamentally expands the scope of oncology nurse navigation beyond discrete treatment transitions.

Ovarian, fallopian tube, and primary peritoneal cancers share common diagnostic and therapeutic pathways, demanding continuity across diagnosis, treatment, recurrence, and survivorship.

What’s Driving Change and Where Implementation Breaks Down

Universal germline and somatic testing for BRCA1/2 mutations and assessment of homologous recombination deficiency (HRD) are now standard at diagnosis and embedded in NCCN-recommended evaluation pathways. Early molecular testing informs eligibility for poly (ADP-ribose) polymerase (PARP) inhibitor maintenance therapy, surgical planning, and counseling on inherited cancer risk.² Importantly, NCCN guidance clarifies that currently available HRD assays are proxy measures rather than definitive predictors of benefit.² For navigators, this distinction matters. Biomarkers guide probability, not certainty, making expectation-setting and informed consent essential components of implementation rather than ancillary tasks.

In practice, delays in testing, incomplete result documentation, and misalignment between diagnostic and treatment timelines remain common points of failure—gaps that disproportionately affect patients with limited access to subspecialty care.

Maintenance Therapy: From “After Treatment” to Active Care

Maintenance therapy represents a second inflection point in the EOC care continuum. Following completion of platinum‑based chemotherapy, many patients transition to maintenance therapy, most commonly with PARP inhibitor maintenance, which may continue for 1 to 3 years in the absence of disease progression. This phase of treatment converts “postchemotherapy” care into an active therapeutic interval that requires ongoing toxicity surveillance, adherence support, and longitudinal assessment of patient‑reported symptoms.²

Wu and colleagues highlight that clinical benefit in real‑world settings depends less on initiation of targeted therapy than on patients’ ability to remain on treatment over time.¹ In the context of maintenance and later‑line targeted therapies, adverse effects such as fatigue and cumulative cytopenias—and, for folate receptor alpha (FRα)-directed antibody-drug conjugates, ocular toxicities related to the cytotoxic payload—are common reasons for early interruption.^1-3 Without structured monitoring and early intervention, these toxicities are frequently underreported, positioning nurse navigators as central to preventing avoidable treatment discontinuation.

Recurrence: Precision Increases, Coordination Must Keep Pace

At recurrence, NCCN guidelines emphasize reassessment rather than rigid reliance on platinum-sensitivity labels alone. Treatment selection incorporates symptom burden, prior toxicities, treatment-free interval, and updated biomarker profiles.² Recent NCCN updates now include FRα-directed antibody-drug conjugates for appropriately selected patients. Data summarized by Wu and colleagues demonstrate that high FRα expression is prevalent in EOC and can enable meaningful responses even in heavily pretreated, platinum-resistant disease—provided that patients are systematically screened and proactively monitored for nonhematologic toxicities.^1,2

The expansion of biomarker-driven therapies intensifies the need for workflow clarity and interdisciplinary communication—domains where navigation infrastructure determines care quality.

The expansion of biomarker-driven therapies intensifies the need for workflow clarity and interdisciplinary communication—domains where navigation infrastructure, rather than individual effort, determines care quality. Immune checkpoint inhibitors play a limited role in EOC, and clinicians reserve them for rare tumors with microsatellite instability-high, meaning defective DNA repair, or high tumor mutational burden under NCCN guidance. This narrow indication reinforces the need to reassess tumor biology at recurrence rather than defaulting to broad immunotherapy use.^1-3

Implications for Navigation Practice

• Embedding molecular testing into diagnostic workflows, rather than treating it as a downstream task
• Aligning imaging, surgical consultation, and systemic therapy decisions to maximize the likelihood of complete cytoreduction
• Standardizing maintenance-phase monitoring, including laboratory surveillance, toxicity education, and adherence checkpoints
• Reengaging patients early at recurrence, with updated molecular review and timely referral for targeted therapies or trials
• As treatment complexity increases, navigators increasingly function as implementation leaders rather than coordinators. Treatment access, continuity, and safety now depend on proactive systems, not ad hoc problem-solving

Call to Action

Precision medicine will not improve EOC outcomes (Figure) unless it is operationalized.^1-4 Oncology nurse navigators are uniquely positioned to translate evolving evidence into reliable care pathways—yet this role requires institutional support, standardized workflows, and measurable accountability. Programs should invest in navigator-led biomarker tracking, maintenance-phase monitoring protocols, and structured reentry pathways at recurrence. Without deliberate implementation, therapeutic innovation risks widening, rather than closing, gaps in ovarian cancer care.

Disclaimer/Commentary Limitations

This commentary reflects the author’s perspective and was not designed to be a systematic review covering all forms of ovarian cancer or management modalities. Since many trials were conducted in North American or European locations, epidemiological and management data may not be generalizable to all regions. In addition, AI-assisted tools were used during manuscript development. Microsoft Copilot was used to support literature exploration and synthesis, and NotebookLM was used in the creation of an accompanying infographic. These tools were used as aids only.

References

1. Wu Y, Xia L, Song C, et al. Complete response to mirvetuximab soravtansine in platinum-resistant recurrent ovarian cancer: a case report. J Ovarian Res. 2025;18:43.
2. Armstrong DK, Alvarez RD, Backes FJ, et al. Ovarian cancer including fallopian tube cancer and primary peritoneal cancer. NCCN Clinical Practice Guidelines in Oncology. Version 3.2025. National Comprehensive Cancer Network; 2025.
3. Moore KN, Angelergues A, Konecny GE, et al. Mirvetuximab soravtansine in FRα-positive, platinum-resistant ovarian cancer. N Engl J Med. 2023;389:2162-2174.
4. Caruso G, Weroha SJ, Cliby W. Ovarian cancer: a review. JAMA. 2025;334:1278-1291.