# High-grade serous ovarian cancer

Source: https://onco.cc/cancers/high-grade-serous-ovarian-cancer/  
OnCo record `high-grade-serous-ovarian-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

High-grade serous cancer is the common, aggressive form of ovarian cancer, now known to start in the fallopian tube. It is treated with surgery and platinum chemotherapy, and maintenance PARP inhibitors have changed its course for the half of patients whose tumours cannot repair DNA properly.

## Summary

High-grade serous carcinoma arises in the fimbria of the fallopian tube and spreads across the peritoneum before it causes symptoms. Every tumour carries a TP53 mutation; about a fifth have a germline or somatic BRCA1 or BRCA2 mutation and roughly half are homologous recombination deficient, which makes them exquisitely sensitive to platinum and to PARP inhibitors. Standard care is complete cytoreductive surgery, before or after three cycles of carboplatin-paclitaxel, with bevacizumab in higher-risk disease, then maintenance: olaparib for BRCA-mutant tumours (SOLO-1), niraparib for all comers (PRIMA) or olaparib with bevacizumab for HRD-positive tumours (PAOLA-1). Secondary surgery helps selected patients at first relapse (DESKTOP III), and platinum-resistant disease has gained mirvetuximab soravtansine for folate receptor alpha-high tumours. Germline testing of every patient and risk-reducing salpingo-oophorectomy in carriers are part of the standard.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: HGSOC; High-grade serous carcinoma of the ovary, fallopian tube and peritoneum
- Tags: subtype-page
- Group: gynaecological
- Burden: About seven in ten ovarian cancers and most of the deaths; three quarters present at stage III or IV, most respond to platinum chemotherapy and most relapse, but PARP inhibitor maintenance now keeps a growing share of BRCA-mutant patients disease-free for years.
- Subtypes: BRCA1 or BRCA2-mutant (germline or somatic, about 20 percent); Homologous recombination deficient without BRCA mutation; Homologous recombination proficient; Primary peritoneal and fallopian tube carcinoma (same disease)
- Biomarkers: TP53 mutation (universal); Germline and somatic BRCA1/2; HRD score (Myriad myChoice or equivalent); Folate receptor alpha (mirvetuximab); CA-125 for monitoring; Platinum-free interval

## Standard of care

- First line: Complete cytoreductive surgery, primary or after three cycles, with carboplatin-paclitaxel for six cycles; bevacizumab added in stage IV or residual disease. ([Carboplatin](https://onco.cc/drugs/carboplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [HIPEC / PIPAC (intraperitoneal chemotherapy)](https://onco.cc/technologies/hipec/))
- Maintenance after first line: Olaparib for BRCA-mutant tumours (SOLO-1), niraparib for all comers (PRIMA), olaparib plus bevacizumab for HRD-positive tumours (PAOLA-1). ([Olaparib](https://onco.cc/drugs/olaparib/), [Niraparib](https://onco.cc/drugs/niraparib/), [SOLO-1](https://onco.cc/trials/solo-1/), [PRIMA / ENGOT-OV26](https://onco.cc/trials/prima/), [PAOLA-1 / ENGOT-ov25](https://onco.cc/trials/paola-1/), [Homologous recombination deficiency (HRD)](https://onco.cc/terms/hrd/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/))
- Platinum-sensitive relapse: Secondary cytoreduction in selected patients (DESKTOP III), platinum doublet, PARP inhibitor maintenance if not already used. ([DESKTOP III / ENGOT-ov20](https://onco.cc/trials/desktop-iii/), [Rucaparib](https://onco.cc/drugs/rucaparib/), [Niraparib](https://onco.cc/drugs/niraparib/))
- Platinum-resistant relapse: Single-agent chemotherapy with or without bevacizumab; mirvetuximab soravtansine for folate receptor alpha-high tumours (MIRASOL); relacorilant with nab-paclitaxel in trials and early approvals. ([Mirvetuximab soravtansine](https://onco.cc/drugs/mirvetuximab-soravtansine/), [Folate receptor alpha](https://onco.cc/targets/folr1/), [Relacorilant](https://onco.cc/drugs/relacorilant/), [Bevacizumab](https://onco.cc/drugs/bevacizumab/))
- Prevention in carriers: Risk-reducing salpingo-oophorectomy around age 35 to 45 by gene; opportunistic salpingectomy at other pelvic surgery for everyone. ([BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [Risk-reducing and opportunistic salpingectomy](https://onco.cc/technologies/risk-reducing-salpingectomy/))

## State of the art

- PARP inhibitor maintenance has turned a disease of relentless relapse into one where a large fraction of BRCA-mutant patients remain disease-free seven years on.
- The fallopian tube origin has made opportunistic salpingectomy a population prevention strategy.
- Antibody-drug conjugates against folate receptor alpha are the first new active drugs in platinum-resistant disease in a decade.

## Open problems

- No screening test lowers mortality.
- Homologous recombination proficient tumours gain little from PARP inhibitors.
- Platinum-resistant disease remains largely incurable.
- Access to HRD testing and PARP inhibitors outside high-income countries.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Ovarian_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Ovarian_cancer

## Connected records

- drugs: [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Mirvetuximab soravtansine](https://onco.cc/drugs/mirvetuximab-soravtansine/), [Niraparib](https://onco.cc/drugs/niraparib/), [Olaparib](https://onco.cc/drugs/olaparib/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Relacorilant](https://onco.cc/drugs/relacorilant/), [Rucaparib](https://onco.cc/drugs/rucaparib/)
- trials: [DESKTOP III / ENGOT-ov20](https://onco.cc/trials/desktop-iii/), [PAOLA-1 / ENGOT-ov25](https://onco.cc/trials/paola-1/), [PRIMA / ENGOT-OV26](https://onco.cc/trials/prima/), [SOLO-1](https://onco.cc/trials/solo-1/)
- targets: [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [Folate receptor alpha](https://onco.cc/targets/folr1/)
- technologies: [HIPEC / PIPAC (intraperitoneal chemotherapy)](https://onco.cc/technologies/hipec/), [Risk-reducing and opportunistic salpingectomy](https://onco.cc/technologies/risk-reducing-salpingectomy/)
- terms: [Homologous recombination deficiency (HRD)](https://onco.cc/terms/hrd/)
- cancers: [Ovarian cancer](https://onco.cc/cancers/ovarian/)

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