High-grade serous ovarian cancer
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.
Overview
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.
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.
Anatomy and lymph node drainage
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
- Fallopian tube fimbria (origin of high-grade serous)BRCA1 or BRCA2-mutant (germline or somatic, about 20 percent) · Homologous recombination deficient without BRCA mutation
- Ovary (other histologies, germ cell)
- Endometrium
- Myometrium (uterine sarcoma)
- Placental site (gestational trophoblastic)
- Cervix, transformation zone
- Vulva
- obturator and external iliac
- internal iliac
- para-aortic (ovary, high uterus)
- inguinal (vulva)
Same organ: Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
Complete cytoreductive surgery, primary or after three cycles, with carboplatin-paclitaxel for six cycles; bevacizumab added in stage IV or residual disease.
Olaparib for BRCA-mutant tumours (SOLO-1), niraparib for all comers (PRIMA), olaparib plus bevacizumab for HRD-positive tumours (PAOLA-1).
Secondary cytoreduction in selected patients (DESKTOP III), platinum doublet, PARP inhibitor maintenance if not already used.
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.
Risk-reducing salpingo-oophorectomy around age 35 to 45 by gene; opportunistic salpingectomy at other pelvic surgery for everyone.
Subtypes & biomarkers
top- 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)
- 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
How often this target appears
- 1996Carboplatin-paclitaxel becomes standard (GOG 111 and successors)
- 2007Fallopian tube fimbria identified as the origin of serous cancer
- 2011Bevacizumab improves progression-free survival (GOG-0218, ICON7)
- 2014Olaparib: first PARP inhibitor approved
- 2018SOLO-1: olaparib maintenance transforms BRCA-mutant first-line outcomes
- 2019PRIMA and PAOLA-1 extend PARP maintenance beyond BRCA
- 2022Mirvetuximab soravtansine approved for platinum-resistant disease
What is in development for High-grade serous ovarian cancer, drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
No screening test lowers mortality.
and how the field plans to fix it →What is being done about thisFinding cancer earlierAvailable now- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
In trialsIdeas and roadmaps- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Homologous recombination proficient tumours gain little from PARP inhibitors.
Platinum-resistant disease remains largely incurable.
and how the field plans to fix it →What is being done about thisResistance to treatmentAvailable now- RelacorilantApproved
- AmivantamabApproved
- CamizestrantApproved
- Comprehensive genomic profilingStandard of care
- Liquid biopsy (ctDNA)Standard of care
- LorlatinibApproved
In trials- ADC payload neutralisersPhase 1
- BGB-16673Phase 3
- Bispecific ADCPhase 3
- BRUIN CLL-321Positive
- CaDAnCe-304Recruiting
- CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)Active
Ideas and roadmaps- A clone report from blood at every treatment cycle
- A fast route to the matched drug when it is licensed for another cancer
- A multi-cancer platform trial of adaptive (dose-holiday) therapy
- A national rapid research autopsy network for end-stage cancer
- A standard evolvability score for every tumour
- A standing platform trial that assigns treatment by how the tumour escaped
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance atlas · Lines of therapy.
Access to HRD testing and PARP inhibitors outside high-income countries.
and how the field plans to fix it →What is being done about thisCost and accessAvailable now- HPV & HBV vaccinationStandard of care
- ImatinibApproved
- Trastuzumab biosimilarsApproved
In trials- Gefitinib vs gefitinib plus pemetrexed-carboplatin in EGFR-mutant lung cancer (Tata Memorial)Positive
- IARC India HPV vaccine dose study (one, two or three doses)Positive
- IMAGINE (varnimcabtagene autoleucel, Immuneel)Positive
- Low-dose nivolumab plus metronomic chemotherapy (Tata Memorial)Positive
- Low-dose olanzapine for cancer anorexia (Tata Memorial)Positive
- METRO PLUS (Tata Memorial Centre, Varanasi)Positive
Ideas and roadmaps- 90-day reliance approval for cancer drugs cleared by two stringent regulators
- A cheap old tablet to restore appetite
- A combination pricing rule so two-drug regimens are not priced as two monopolies
- A coordinated reserve and shared schedule for the world's medical isotope reactors
- A dedicated global financing window for cancer, modelled on the Global Fund
- A delinked market-entry reward paid by payers when a repurposed generic wins approval
Background: Accelerated approval, Biosimilar, Real-world evidence. Also on OnCo: Financial help · Coverage by country · HTA decisions.
Trials
topTrials recruiting now
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Landmark trials
Expert centres
topExpert centres
- via Olaparib
- via HIPEC / PIPAC (intraperitoneal chemotherapy)
- ARCAGY-GINECOParis, FRvia Olaparib, Niraparib, PAOLA-1 / ENGOT-ov25, Homologous recombination deficiency (HRD)
- via Olaparib, Mirvetuximab soravtansine, Folate receptor alpha
- Sheba Medical CenterRamat Gan, ILvia Olaparib, BRCA1 / BRCA2 (HRD)
- via BRCA1 / BRCA2 (HRD)
- Alliance for Clinical Trials in OncologyChicago, IL, USvia Carboplatin
- Breast Cancer TrialsNewcastle, NSW, AUvia Olaparib
- Breast International Group (BIG)Brussels, BEvia Olaparib
- Centre hospitalier de l'Université de Montréal (CHUM)Montréal, QC, CAvia Olaparib
- via HIPEC / PIPAC (intraperitoneal chemotherapy)
- European Society of Surgical OncologyBrussels, BEvia HIPEC / PIPAC (intraperitoneal chemotherapy)
- First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, CNvia HIPEC / PIPAC (intraperitoneal chemotherapy)
- German Breast Group (GBG)Neu-Isenburg, DEvia Carboplatin
- GOG FoundationPhiladelphia, PA, USvia Mirvetuximab soravtansine
- via Olaparib
- Hadassah Medical CenterJerusalem, ILvia BRCA1 / BRCA2 (HRD)
- Hospital de Clínicas de Porto AlegrePorto Alegre, BRvia BRCA1 / BRCA2 (HRD)
- via BRCA1 / BRCA2 (HRD)
- Institute of Oncology LjubljanaLjubljana, SIvia Carboplatin
- via BRCA1 / BRCA2 (HRD)
- Lagos University Teaching HospitalLagos, NGvia BRCA1 / BRCA2 (HRD)
- LYSA (The Lymphoma Study Association)Pierre-Bénite (Lyon), FRvia PRIMA / ENGOT-OV26
- via Folate receptor alpha
- Newcastle Cancer Centre / Northern Centre for Cancer CareNewcastle upon Tyne, GBvia BRCA1 / BRCA2 (HRD)
- NRG OncologyPhiladelphia, PA, USvia Olaparib
- via Folate receptor alpha
- QIMR Berghofer Medical Research InstituteBrisbane, AUvia BRCA1 / BRCA2 (HRD)
- Shaare Zedek Medical CenterJerusalem, ILvia BRCA1 / BRCA2 (HRD)
- Society of Gynecologic OncologyChicago, IL, USvia PAOLA-1 / ENGOT-ov25
- Society of Surgical OncologyRosemont, IL, USvia HIPEC / PIPAC (intraperitoneal chemotherapy)
- The Institute of Cancer ResearchLondon, GBvia Olaparib
- UNICANCERParis, FRvia HIPEC / PIPAC (intraperitoneal chemotherapy)
- University of Malaya Medical CentreKuala Lumpur, MYvia BRCA1 / BRCA2 (HRD)
Questions to ask
topQuestions to ask your oncologist about High-grade serous ovarian cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example TP53 mutation, Germline and somatic BRCA1/2, HRD score, Folate receptor alpha, CA-125 for monitoring), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include BRCA1 or BRCA2-mutant, Homologous recombination deficient without BRCA mutation, Homologous recombination proficient.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
First line
- For my situation (first line), which of the standard options do you recommend and why?Why: Guideline options include: Complete cytoreductive surgery, primary or after three cycles, with carboplatin-paclitaxel for six cycles; bevacizumab added in stage IV or residual disease.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Bevacizumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Maintenance after first line
- For my situation (maintenance after first line), which of the standard options do you recommend and why?Why: Guideline options include: Olaparib for BRCA-mutant tumours (SOLO-1), niraparib for all comers (PRIMA), olaparib plus bevacizumab for HRD-positive tumours (PAOLA-1).
- Am I a candidate for Olaparib, Niraparib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of SOLO-1 and PRIMA / ENGOT-OV26 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Platinum-sensitive relapse
- For my situation (platinum-sensitive relapse), which of the standard options do you recommend and why?Why: Guideline options include: Secondary cytoreduction in selected patients (DESKTOP III), platinum doublet, PARP inhibitor maintenance if not already used.
- Am I a candidate for Rucaparib, Niraparib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of DESKTOP III / ENGOT-ov20 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Platinum-resistant relapse
- For my situation (platinum-resistant relapse), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- Am I a candidate for Mirvetuximab soravtansine, Relacorilant, Bevacizumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Prevention in carriers
- For my situation (prevention in carriers), which of the standard options do you recommend and why?Why: Guideline options include: Risk-reducing salpingo-oophorectomy around age 35 to 45 by gene; opportunistic salpingectomy at other pelvic surgery for everyone.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “No screening test lowers mortality”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Homologous recombination proficient tumours gain little from PARP inhibitors”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
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Direct links plus the targets, companies, and technologies of this cancer's products.
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topQuery for this cancer: (TITLE:"High-grade serous ovarian cancer" OR ABSTRACT:"High-grade serous ovarian cancer" OR TITLE:"HGSOC" OR ABSTRACT:"HGSOC" OR TITLE:"High-grade serous carcinoma of the ovary, fallopian tube and peritoneum" OR ABSTRACT:"High-grade serous carcinoma of the ovary, fallopian tube and peritoneum") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about High-grade serous ovarian cancer, not a curated reading list.
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