Advanced Therapeutic Approaches for Metastatic Ovarian Cancer

Ovarian cancer is the leading cause of cancer-related death among women, which ranks as the eighth most common gynecological cancer. Although several cytoreductive surgeries and chemotherapies have been attempted to address ovarian cancer, the disease still shows poor prognosis and survival rate due to prevalent metastasis. Peritoneal metastasis is recognized as the primary route of metastatic progression in ovarian cancer, leading to severe symptoms in patients and is generally difficult to detect at an early stage. Current anti-cancer therapy is insufficient to completely treat ovarian cancer, particularly in cases where the disease has progressed to metastasis, due to its high rates of recurrence and resistance. Therefore, it is imperative to develop effective strategies for treating metastatic ovarian cancer. Given that various signaling pathways, including TGF-β, NF-κB, and PI3K/AKT/mTOR pathways, influence cancer progression, their interactions within the tumor microenvironment (TME) are particularly significant. TME plays a critical role in driving metastatic features in ovarian cancer through altered immunologic interactions. Recent therapeutic advances have focused on targeting these distinct features to improve treatment outcomes. Deciphering the complex interaction between signaling pathways and immune populations contributing to metastatic ovarian cancer provides an opportunity to enhance anti-cancer efficacy. Hereby, this review highlights the mechanisms of signaling pathways in metastatic ovarian cancer and immunological interactions to understand improved immunotherapy against ovarian cancer.