Molecular Pathogenesis Early Detection Strategies and Precision Therapeutic Advances in Ovarian Cancer

Introduction: Ovarian cancer remains the most lethal gynecological malignancy worldwide, primarily due to late-stage diagnosis, extensive molecular heterogeneity, and the development of therapeutic resistance. Although advances in cytoreductive surgery and platinum-based chemotherapy have improved short-term disease control, durable long-term survival improvements remain modest, particularly in patients with recurrent or platinum-resistant disease. Rapid progress in molecular profiling, targeted therapeutics, and artificial intelligence–based diagnostic tools has transformed the understanding and management of ovarian cancer. However, translating these scientific advances into consistent clinical benefit remains challenging due to therapeutic resistance, limited validation of emerging biomarkers, and disparities in access to precision oncology. Methods: This narrative review synthesizes current evidence from peer-reviewed clinical trials, translational studies, and systematic reviews examining molecular pathogenesis, early detection strategies, and therapeutic developments in ovarian cancer. Literature was identified through structured searches of major biomedical databases, focusing on studies evaluating molecular biomarkers, artificial intelligence–driven diagnostic approaches, targeted therapies—including poly (ADP-ribose) polymerase inhibitors and anti-angiogenic agents—and emerging treatment modalities such as immunotherapy, antibody–drug conjugates, and cellular therapies. Particular emphasis was placed on identifying conflicting findings, methodological limitations, and translational barriers affecting clinical implementation. Results: Advances in genomic and molecular characterization have established ovarian cancer as a biologically heterogeneous disease comprising multiple histological and molecular subtypes with distinct clinical behavior and therapeutic responsiveness. Targeted therapies, particularly PARP inhibitors, have significantly improved progression-free survival in patients with homologous recombination deficiency; however, long-term efficacy is frequently limited by acquired resistance mechanisms, including restoration of homologous recombination function and activation of alternative DNA repair pathways. Emerging diagnostic technologies—including circulating tumor DNA, multi-omics biomarker panels, and artificial intelligence–based predictive models—demonstrate promising diagnostic accuracy for early-stage disease detection. Nevertheless, many of these technologies remain in early clinical development and require large-scale prospective validation before routine adoption in clinical practice. Discussion: Despite substantial scientific progress, several translational gaps continue to limit the real-world impact of precision oncology in ovarian cancer. Variability in biomarker performance across populations, heterogeneity in study design, and reliance on retrospective datasets complicate interpretation of current evidence. In addition, the relatively modest response rates observed with immunotherapy highlight the importance of understanding tumor immune evasion mechanisms and optimizing combination treatment strategies. Emerging therapies, including antibody–drug conjugates and chimeric antigen receptor T-cell therapies, show encouraging early clinical activity but remain under active investigation. Addressing these challenges will require interdisciplinary collaboration, standardized biomarker validation frameworks, and integration of computational tools into routine clinical workflows. Conclusion: Ovarian cancer management is undergoing a paradigm shift toward precision oncology driven by advances in molecular biology, biomarker discovery, and targeted therapeutics. However, durable improvements in survival will depend on overcoming therapeutic resistance, validating early detection strategies in diverse populations, and ensuring equitable access to advanced diagnostics and personalized treatments. Future research should prioritize prospective validation of emerging technologies, development of biomarker-guided treatment strategies, and translation of scientific innovation into sustainable clinical outcomes.