# 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: gynaecologic
- 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

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/high-grade-serous-ovarian-cancer/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/#overview [3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/#what-it-is [4 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/#finding-it [6 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/#treating-it [5 settings, 4 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/#evidence [16 trials, 6 key papers, 7 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/#science [4 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/#living-with-it [20 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/coming/ [8 medicines, 16 trials, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/high-grade-serous-ovarian-cancer/data/ [63 connected records]

## 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 that nearly always relapsed 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

- cancers: [Clear cell ovarian cancer](https://onco.cc/cancers/clear-cell-ovarian-cancer/), [Low-grade serous ovarian cancer](https://onco.cc/cancers/low-grade-serous-ovarian-cancer/), [Mucinous ovarian cancer](https://onco.cc/cancers/mucinous-ovarian-cancer/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Platinum-resistant ovarian cancer](https://onco.cc/cancers/platinum-resistant-ovarian-cancer/), [Platinum-sensitive ovarian cancer](https://onco.cc/cancers/platinum-sensitive-ovarian-cancer/)
- trials: [A Clinical Study of Raludotatug Deruxtecan in People With Ovarian Cancer (MK-5909-003)](https://onco.cc/trials/nct06843447/), [A Study of Azenosertib (ZN-c3) in Subjects With Platinum-Resistant High-Grade Serous Ovarian, Fallopian Tube or Primary Peritoneal Cancer](https://onco.cc/trials/nct05128825/), [A Study of Azenosertib (ZN-c3) Versus Investigator's Choice Chemotherapy in Subjects With Platinum-Resistant High-Grade Serous Ovarian, Primary Peritoneal, or Fallopian Tube Cancers Positive for Cyclin E1 Protein Expression](https://onco.cc/trials/nct07546500/), [A Study of Radspherin® in Patients With Primary Advanced Epithelial Cancer, With Peritoneal Metastasis That Are Homologous Recombination Proficient Scheduled to Undergo Neoadjuvant Chemotherapy and Interval Debulking Surgery](https://onco.cc/trials/nct06504147/), [Chemotherapy Combined With Propranolol Hydrochloride as Neoadjuvant Therapy for Advanced High-grade Serous Ovarian Cancer](https://onco.cc/trials/nct07125391/), [D9319C00001- 1L OC Mono Global RCT](https://onco.cc/trials/nct04884360/), [DESKTOP III / ENGOT-ov20](https://onco.cc/trials/desktop-iii/), [Dual-Targeting CAR-NK Cells for Recurrent Ovarian Cancer (MSLN, FRα, MUC16)](https://onco.cc/trials/nct07480954/), [Dual-Targeting CAR-NK Cells for Recurrent Ovarian Cancer (MSLN, FRα, MUC16) pt2](https://onco.cc/trials/nct07617753/), [IN10018 in Combination With Standard Chemotherapy in High-grade Serous Epithelial Ovarian Cancer](https://onco.cc/trials/nct05551507/), [p53 Activation in Platinum-Resistant High Grade Serous Ovarian Cancer, a Study of PLD With APR-246](https://onco.cc/trials/nct03268382/), [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/), [SORAYA](https://onco.cc/trials/soraya/), [Trial of THEO-260 in Ovarian Cancer Patients](https://onco.cc/trials/nct06618235/)
- key papers: [Comprehensive molecular portraits of human breast tumours](https://onco.cc/key-papers/paper-tcga-breast-molecular-portraits-nature-2012/), [Integrated genomic analyses of ovarian carcinoma (The Cancer Genome Atlas)](https://onco.cc/key-papers/paper-tcga-ovarian-nature-2011/), [MIRASOL: mirvetuximab soravtansine versus chemotherapy in folate receptor alpha-high platinum-resistant ovarian cancer](https://onco.cc/key-papers/paper-mirasol-nejm-2023/), [PAOLA-1: olaparib added to bevacizumab maintenance in newly diagnosed ovarian cancer, with benefit confined to HRD-positive tumours](https://onco.cc/key-papers/paper-paola-1-nejm-2019/), [PRIMA: niraparib maintenance in newly diagnosed advanced ovarian cancer](https://onco.cc/key-papers/paper-prima-niraparib-nejm-2019/), [SOLO-1: two years of olaparib maintenance after first-line chemotherapy for BRCA-mutated ovarian cancer](https://onco.cc/key-papers/paper-solo-1-nejm-2018/)
- 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/)
- 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/), [HRD genomic scar scores (GIS, LOH, HRDetect)](https://onco.cc/technologies/hrd-genomic-scar-scores/), [RAD51 foci assay (functional HRD test)](https://onco.cc/technologies/rad51-foci-assay/), [Risk-reducing and opportunistic salpingectomy](https://onco.cc/technologies/risk-reducing-salpingectomy/)
- terms: [Basal-like breast cancer](https://onco.cc/terms/basal-like/), [BRCA reversion mutations](https://onco.cc/terms/brca-reversion-mutations/), [Homologous recombination deficiency (HRD)](https://onco.cc/terms/hrd/)
- biomarkers: [Folate receptor alpha expression (FRα-positive, PS2+ >= 75%)](https://onco.cc/biomarkers/folr1-expression/), [Germline BRCA1/2 pathogenic variant (gBRCAm)](https://onco.cc/biomarkers/brca-germline/), [HRD-positive (genomic instability score)](https://onco.cc/biomarkers/hrd-positive/), [Tumour (somatic or germline) BRCA1/2 mutation and HRR gene alterations](https://onco.cc/biomarkers/brca-somatic/)
- companies: [AGO Study Group](https://onco.cc/companies/ago-study-group/)

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JSON: https://onco.cc/api/v1/entities/high-grade-serous-ovarian-cancer.json