May brought a notably full month of published ovarian cancer research, with meaningful findings across treatment, biomarker science, surgery, and patient experience. The strongest clinical signals came from a phase 1/2 immunotherapy trial combining a survivin-targeting vaccine with pembrolizumab, real-world data on HRD testing patterns across Europe, and new insights into why ascites fluid (the abdominal fluid that often accumulates in ovarian cancer) may be helping tumors survive standard treatment. This digest also covers qualitative research on what prehabilitation means to patients facing surgery. *The papers highlighted here represent a selection of those published during the month. The papers were selected and summarized by AI. Accuracy of the summaries was confirmed by a scientist.* This digest incorporates only open-access research articles that are free to be read by the entire community and that are explicitly licensed to be shared and reused. --- **A survivin-targeting vaccine combined with immunotherapy showed activity in recurrent ovarian cancer** For people whose ovarian cancer has come back, finding treatments that work, especially after prior therapies, remains one of the field's hardest problems. Immunotherapy approaches, which try to help the body's immune system recognize and attack cancer cells, have mostly disappointed in ovarian cancer. New results from a phase 1/2 clinical trial called PESCO offer a reason for cautious optimism. - Researchers in Toronto tested a treatment called maveropepimut-S (a therapeutic vaccine, meaning a vaccine designed to treat existing cancer rather than prevent it) alongside the checkpoint inhibitor pembrolizumab (which blocks a signal cancer cells use to hide from the immune system) and low-dose cyclophosphamide (a chemotherapy used here to dampen suppressive immune cells that might otherwise blunt the response). Among 44 evaluable patients with recurrent epithelial ovarian cancer, the overall response rate was 23% and the disease control rate was 67%. Results were more pronounced in platinum-sensitive disease (median progression-free survival 6.3 months) than in platinum-resistant disease (1.2 months). Importantly, 62.5% of tested patients mounted a measurable immune response against survivin (a protein ovarian cancer cells often over-produce) and that immune response correlated with clinical benefit. Most side effects were grade 1 or 2, with injection site reactions being the most common. This is a phase 1/2 trial, meaning it is an early-stage study designed primarily to evaluate safety and gather initial efficacy data, not to definitively prove benefit. Larger trials are needed. ([Read the full paper](https://doi.org/10.1038/s41467-026-72125-0)) --- **HRD testing patterns in real-world practice reveal wide variation in who gets tested and how results shape treatment** Homologous recombination deficiency, or HRD (a measure of how well cancer cells can repair certain kinds of DNA damage) has become an important factor in deciding who benefits most from PARP inhibitors, a class of drugs that block cancer cells' ability to repair their own DNA. But how is HRD testing actually being used in practice, outside of clinical trials? - A real-world study from Bulgaria enrolled 100 patients with newly diagnosed advanced ovarian cancer who had undergone HRD testing. Among them, 58% had HRD-positive tumors, of which about one-third carried BRCA mutations. The most common first-line treatment was platinum-taxane chemotherapy plus an anti-angiogenic drug called bevacizumab (which works by cutting off blood vessel growth that tumors depend on). Among patients who survived to start maintenance therapy, the combination of a PARP inhibitor plus bevacizumab was widely used, even in HRD-negative patients, which the study authors note is a clinical practice pattern worth watching. This real-world dataset provides a snapshot of current practice in Eastern Europe and adds to growing international evidence about how precision biomarker testing translates into real-world treatment decisions. ([Read the full paper](https://doi.org/10.3390/medicina62051000)) - A companion dataset from Estonia profiled 339 ovarian cancer tumor samples using next-generation sequencing, a technology that reads tumor DNA to find mutations and other alterations. Among those patients, 37.5% had actionable alterations at the highest evidence level, most commonly in BRCA1, BRCA2, KRAS, and BRAF. HRD was present in 53.2% of high-grade serous tumors. Notably, germline testing (a blood test looking for inherited gene changes) had only been performed in 42% of patients, suggesting that many people who could benefit from knowing their inherited risk have not yet been tested. ([Read the full paper](https://doi.org/10.2340/1651-226X.2026.45612)) --- **Mirvetuximab soravtansine, a targeted treatment for platinum-resistant ovarian cancer, shows comparable results in Chinese patients** Mirvetuximab soravtansine, often called MIRV, is an antibody-drug conjugate (ADC), which is a treatment that pairs a targeting antibody (which homes in on a protein called folate receptor alpha, or FRα, found on most ovarian cancer cells) with a cell-killing payload. It is already approved for FRα-positive platinum-resistant ovarian cancer based on the MIRASOL trial. A question that remained was how it performs in Chinese patients, who may differ in pharmacokinetics (how the drug moves through the body) and clinical context. - A phase I study enrolled 19 Chinese patients with FRα-overexpressing platinum-resistant ovarian cancer and tested MIRV at 5 and 6 mg/kg doses. The most common grade 3 or higher side effects were decreased platelet count (21%), decreased lymphocyte count (16%), and anemia (16%). Importantly, the drug's pharmacokinetic profile in Chinese patients was comparable to what has been reported in Caucasian patients, supporting the potential for MIRV to be used more broadly in East Asian populations. Among 15 evaluable patients, the objective response rate was 26.7%, consistent with prior data. No anti-drug antibodies were detected. This was a small, early-phase study without a comparison group, but the findings support regulatory consideration for this treatment in China. ([Read the full paper](https://doi.org/10.1002/cam4.71704)) - A separate health economic analysis from Germany modeled the cost-effectiveness of MIRV compared to standard chemotherapy in the German healthcare system, using data from the MIRASOL trial. The analysis found MIRV provided meaningful improvements in both life-years and quality-adjusted life-years, but at an incremental cost-effectiveness ratio far exceeding typical German thresholds, meaning that at its current price, MIRV would likely not be considered cost-effective in Germany without negotiated price reductions. About 75–90% of ovarian cancers are FRα-positive, making this a treatment relevant to a large proportion of the community. ([Read the full paper](https://doi.org/10.1007/s00432-026-06488-8)) --- **Ascites fluid may be actively protecting ovarian cancer from cell death, and this could be a treatment target** One of the defining features of advanced ovarian cancer is ascites, fluid that accumulates in the abdominal cavity. It's also one of the reasons ovarian cancer spreads so efficiently along the peritoneum (the lining of the abdomen). A study published in *Nature Communications* this month adds mechanistic depth to why this matters. - Researchers at Duke University found that ascites fluid from patients protects ovarian cancer cells from ferroptosis, a specific, iron-dependent form of cell death that the immune system and certain therapies try to trigger. Ascites suppresses ferroptosis through two mechanisms: downregulating a protein called HMGCS2, which leads to increased fat droplet accumulation in cancer cells, and blunting the increase of a transferrin receptor that would otherwise let more iron in. In animal models, treating with lipid-lowering fibrate drugs (a class of medications already used clinically to manage cholesterol) reversed the ascites-driven protection and reduced peritoneal tumor growth. This is preclinical research, meaning it was conducted in cell cultures and mice, not in patients. But the identification of ascites-mediated ferroptosis protection as a mechanism of metastatic spread and the suggestion that widely available medications might counteract it is notable enough to flag for the field. ([Read the full paper](https://doi.org/10.1038/s41467-026-72116-1)) --- **CAR-T cell therapy for ovarian cancer: where things stand, and why NK and macrophage approaches may offer advantages** CAR (chimeric antigen receptor) therapies are genetically engineered immune cells designed to recognize and kill cancer. In blood cancers, CAR-T (which uses T cells) has transformed treatment. In solid tumors like ovarian cancer, the story has been harder. - A published review systematically compared three types of CAR-based approaches for ovarian cancer: CAR-T (the most studied), CAR-NK (using natural killer cells), and CAR-macrophage approaches. The review highlights that while CAR-T therapies face significant challenges in ovarian cancer, including the immunosuppressive tumor microenvironment, off-target toxicity, and difficulty finding tumor-specific targets, CAR-NK cells and CAR-macrophages may have distinct advantages. CAR-NK cells can kill cancer through both CAR-dependent and CAR-independent pathways, avoiding the severe cytokine release syndrome that can occur with CAR-T. CAR-macrophages have an unusual ability to infiltrate solid tumors and remodel the tumor microenvironment. No CAR-based therapy is currently approved for ovarian cancer; this is an area under active clinical development. ([Read the full paper](https://doi.org/10.1002/cam4.71897)) --- **Predicting PARP inhibitor benefit: new data on dosing, resistance, and who responds** PARP inhibitors, a class of drugs that exploit cancer cells' DNA repair vulnerabilities, remain central to ovarian cancer treatment. May brought several additions to the evolving picture of how to use them well. - A retrospective Chinese study of 145 patients receiving first-line PARP inhibitor maintenance therapy developed and validated a prognostic tool (called a nomogram) to predict who does best. Independent factors for longer progression-free survival included BRCA mutation status, complete surgical resection (no visible remaining disease), FIGO stage III versus IV, and a higher CA-125 elimination rate, a biomarker that tracks how quickly tumor markers fall during chemotherapy, suggesting tumor sensitivity. Younger age and BRCA mutations also predicted better overall survival. In a finding worth noting, longer duration of PARP inhibitor therapy (more than 12 months) was associated with worse subsequent outcomes, possibly reflecting selection for resistant disease. ([Read the full paper](https://doi.org/10.1002/cam4.71891)) - Another study investigated a protein called SAA1 (serum amyloid A1) that is highly expressed in late-stage high-grade serous ovarian carcinoma. Researchers found that SAA1 secreted by tumor cells activates tumor-associated macrophages (immune cells that normally should fight cancer but are reprogrammed to support it instead), which then release CXCL1, a signaling protein that promotes cancer cells' ability to spread. This SAA1–macrophage–CXCL1 axis represents a potential new target for preventing peritoneal metastasis. This is preclinical and translational research; clinical applications would require further development. ([Read the full paper](https://doi.org/10.1002/ctm2.70698)) - Researchers also explored EV-DNA, DNA carried inside extracellular vesicles (tiny particles shed by cancer cells into body fluids like ascites), as a potential liquid biopsy approach. A study found that copy number variation patterns in EV-DNA from ascites fluid closely mirrored tumor DNA, and a panel of five genes showed strong predictive performance for identifying patients likely to respond to PARP inhibitors (olaparib), with an area under the curve of 0.91. This kind of non-invasive test could help personalize treatment selection, though it remains in the research phase. ([Read the full paper](https://doi.org/10.1002/jev2.70308)) --- **What patients with ovarian cancer actually experience during prehabilitation, and what helps or hinders engagement** Before major surgery like cytoreductive surgery (an operation to remove as much tumor as possible), some patients are enrolled in "prehabilitation" programs — structured interventions to improve physical, nutritional, and psychological readiness for surgery. These programs make intuitive sense, but how do patients actually experience them? - A multi-centre qualitative study from the UK conducted in-depth semi-structured interviews with 21 patients with advanced (stage III–IV) ovarian cancer who had been referred to a prehabilitation program. Four themes emerged: how patients were introduced to the program (timing and volume of information mattered), perceived need (patients with strong support networks or high baseline fitness sometimes didn't see the point), how the program was delivered (accessible staff and family involvement helped; logistical barriers hurt), and what they wanted after surgery (they wanted the program to address ongoing gynaecological health and offer closure). The study found that prehabilitation was generally acceptable to patients, but that a lack of perceived need was the main barrier, suggesting that how these programs are framed and communicated may be as important as what they include. ([Read the full paper](https://doi.org/10.1136/bmjoq-2025-003677)) --- **Biomarker research: early detection and aging-related immunosuppression** One puplication this month addressed questions about the immune tumor microenvironment and early detection. - A study used mouse models to show that older animals with ovarian cancer had expanded populations of regulatory T cells (immune cells that suppress the immune response) within the tumor microenvironment. These Tregs were metabolically distinct, running on a fuel called succinate, and blocking that metabolic pathway restored normal T cell activity and improved immune response. This is early-stage preclinical research, but it adds to evidence that age-related immune changes may partly explain why older patients sometimes have different outcomes and suggests metabolic pathways as potential targets. ([Read the full paper](https://doi.org/10.1111/acel.70510)) --- **What Does This Mean for Me?** **Is there any reason for hope about immunotherapy in ovarian cancer?** The PESCO trial results are promising, even at this early stage. A 23% response rate with a well-tolerated regimen (in patients with recurrent disease who had already received prior treatment) stands out in a disease where immunotherapy has largely failed. What makes this approach different is the vaccine component: rather than just releasing the brakes on the immune system (which is what pembrolizumab does alone), maveropepimut-S tries to direct the immune system toward a specific target on ovarian cancer cells. The correlation between immune response and clinical benefit is an encouraging sign. But this is a phase 1/2 trial with 44 patients. If you're living with recurrent ovarian cancer, it's worth asking your oncologist: *"Are there immunotherapy trials I might be eligible for, including vaccine-based approaches?"* **Should I ask about HRD testing, and is it different from BRCA testing?** Yes, they are different, and both matter. BRCA testing looks for specific mutations (inherited or in the tumor) in the BRCA1 and BRCA2 genes. HRD testing is broader; it looks for a pattern of DNA damage across the whole tumor genome that suggests the tumor cannot repair certain breaks, making it vulnerable to PARP inhibitors even without a BRCA mutation. The real-world studies from Bulgaria and Estonia published this month reinforce that HRD testing is being adopted into clinical practice but that access and uptake remain uneven across countries. If you've been diagnosed with ovarian cancer and aren't sure whether you've had both BRCA testing (ideally from both a blood test and a tumor test) and HRD testing, it's worth asking: *"Has my tumor been tested for HRD status? How does that affect my maintenance therapy options?"* **What is ascites, and why does this new research matter?** Ascites is fluid that builds up in the abdomen; it's a common symptom in advanced ovarian cancer and often signals that cancer has spread along the peritoneum. The Duke study published this month in *Nature Communications* shows that ascites doesn't just accumulate passively: it may actively protect cancer cells from a form of cell death the body would otherwise use against them. This is preclinical research (meaning it was done in cells and mice) so it doesn't change treatment recommendations today. But it opens a new way of thinking about why ovarian cancer spreads the way it does, and whether medications that are already in clinical use (like fibrates) might someday play a role in preventing peritoneal spread. *This digest is prepared by OCRA (Ovarian Cancer Research Alliance) for patients, caregivers, and advocates. It is intended to inform, not to guide individual treatment decisions. Please speak with your care team about what research findings may mean for your specific situation.* --- **Sources** **Directly Referenced in This Digest** 1. Veneziani AC, et al. "Maveropepimut-S, pembrolizumab and low dose cyclophosphamide in metastatic ovarian cancer: phase 1/2 PESCO trial." *Nature Communications.* May 14, 2026. PMID 42129168. 2. Arabadjiev J, et al. "Prevalence of Homologous Recombination Deficiency and Treatment Patterns in Patients with Newly Diagnosed Advanced Ovarian Cancer in Bulgaria: A Real-World Cohort Study (VALIDATE)." *Medicina (Kaunas).* May 21, 2026. PMID 42195253. 3. Tooming M, et al. "Exploring the somatic mutational landscape of ovarian cancer in Estonia." *Acta Oncologica.* May 18, 2026. PMID 42145025. 4. Li Y, et al. "Safety, Tolerability, and Pharmacokinetics of Mirvetuximab Soravtansine in Chinese Patients With Folate Receptor α-Positive Advanced Ovarian Cancer." *Cancer Medicine.* May 2026. PMID 42165281. 5. Janke FF, et al. "Health economic evaluation of Mirvetuximab soravtansine for the treatment of FRα-positive, platinum resistant ovarian cancer in Germany." *Journal of Cancer Research and Clinical Oncology.* May 21, 2026. PMID 42162501. 6. Setayeshpour Y, et al. "Ascites protects against ferroptosis and enables the peritoneal growth of ovarian cancer." *Nature Communications.* May 11, 2026. PMID 42115216. 7. Wang L, et al. "Different Immune Cells Modified With Chimeric Antigen Receptors Are Being Applied to Ovarian Cancer: Which Is the Most Effective?" *Cancer Medicine.* May 2026. PMID 42068103. 8. Tan S, et al. "Prognostic Nomogram for Ovarian Cancer Patients on First-Line Maintenance Therapy With PARP Inhibitors: A Retrospective Cohort Study." *Cancer Medicine.* May 2026. PMID 42169627. 9. Zhou X, et al. "Tumour-derived SAA1 reprogrammes macrophages to promote CXCL1-mediated metastasis in Ovarian Cancer." *Clinical and Translational Medicine.* May 2026. PMID 42145073. 10. Uekusa R, et al. "DNA Copy Number Profiling in Extracellular Vesicles as Clinical Biomarkers of High-Grade Serous Ovarian Carcinoma." *Journal of Extracellular Vesicles.* May 2026. PMID 42139280. 11. McMullan JC, et al. "Patient perspectives of multimodal prehabilitation for ovarian cancer with surgical intent: a multicentre qualitative evaluation of acceptability, barriers and facilitators for participation." *BMJ Open Quality.* May 18, 2026. PMID 42150817. 12. Udumula MP, et al. "Aging-Driven Immunosuppression: The Role of Tregs in the Ovarian Tumor Microenvironment." *Aging Cell.* May 2026. PMID 42033075. --- **Additional Open-Access Papers Published in May 2026 on Related Topics** 13\. Yuk JS, Yoon SH. "Effect of hysterectomy on the risk of ovarian cancer: A South Korean national cohort study." *PLoS One.* May 6, 2026. PMID 42090413. 14. Roos Alexander H, et al. "Predictive ability of novel glycovariant biomarkers of CA125 and CA15-3 up to three years prior to ovarian cancer diagnosis: a population-based case-control study." *Journal of Ovarian Research.* May 29, 2026. PMID 42215983. *(Case-control study evaluating novel CA125 and CA15-3 glycovariant biomarkers for early detection up to 3 years before diagnosis; found glycovariants did not outperform standard CA125 in asymptomatic women.)* 15. Zhang J, et al. "Two-staged CT-based radiomics model in characterising early-stage ovarian carcinoma and benign ovarian masses." *Journal of Ovarian Research.* May 1, 2026. PMID 42067904. *(Multi-centre radiomics study using CT imaging and machine learning to distinguish early-stage ovarian cancer from benign masses; achieved AUC of 0.859–0.918.)* 16. Deng L, et al. "Ubiquitin-specific proteases in ovarian cancer: molecular mechanisms and therapeutic implications." *Journal of Ovarian Research.* May 19, 2026. PMID 42157319. *(Review of how deubiquitinase enzymes regulate cancer hallmarks in ovarian cancer and their potential as therapeutic targets alongside PARP inhibitors and platinum.)* 17. Arya R, et al. "Pyroptosis-Related Gene Signatures and Immune Modulation in Ovarian Cancer: Insights from Multi-Omics and Machine Learning." *Genes (Basel).* May 21, 2026. PMID 42195052. *(Bioinformatics study using machine learning to identify pyroptosis-related biomarkers; CEP55 identified as high-accuracy diagnostic biomarker and potential therapeutic target.)* 18. Rubio MA, et al. "Combined Effect of Metformin and miR-145/miR-23b Co-Transfection on Proliferation and Progression in 2D and 3D Epithelial Ovarian Cancer Models." *Cells.* May 19, 2026. PMID 42193942. *(Preclinical study combining metformin with tumor-suppressor microRNAs; reduced proliferation and migration in 2D models but found 3D spheroids show intrinsic resistance.)* 19. Min Y, et al. "The USP19-DnaJC7 Axis Stabilizes p53 in Cisplatin-Treated Epithelial Ovarian Cancer." *Cells.* May 18, 2026. PMID 42193933. *(Preclinical research identifying a deubiquitinase axis that stabilizes the p53 tumor suppressor during cisplatin treatment; potential strategy to enhance chemotherapy efficacy.)* 20. Pawlik P, et al. "Genetic Variations in the Fibronectin 1 Gene (FN1) and Risk of Female Reproductive Cancers—A Preliminary Study." *International Journal of Molecular Sciences.* May 12, 2026. PMID 42196282. *(Preliminary study finding FN1 gene variants may slightly increase ovarian cancer risk; requires larger validation cohorts.)* 21. Han YJ, et al. "Regulation of antiviral and antitumor immunity by the BRCA1P1 pseudogene in human cancers." *PNAS.* May 4, 2026. PMID 42081726. *(Preclinical study identifying a BRCA1-derived pseudogene as a regulator of innate immune defense in breast and ovarian cancers; inhibiting it enhanced antitumor immunity and drug sensitivity.)* 22. Zoń A, Bednarek IA. "Autophagy in Ovarian Cancer, an Opportunity or an Additional Threat?" *International Journal of Molecular Sciences.* May 9, 2026. PMID 42196188. *(Review examining the dual role of autophagy — a cellular recycling process — in promoting or suppressing ovarian cancer and its contribution to drug resistance.)* 23. Aloisi M, et al. "A Narrative Review of Recent Insights on Nerve Growth Factor Signaling in Physiological and Pathological Ovarian Processes in Mammals." *Biomolecules.* May 8, 2026. PMID 42194047. *(Review of nerve growth factor (NGF) signaling in ovarian biology, including its potential role in ovarian cancer progression.)* 24. Phillip A, et al. "Emerging Near-Infrared Targeted Imaging Pharmaceutics for Ovarian Cancer." *Pharmaceutics.* May 6, 2026. PMID 42198268. *(Review of near-infrared imaging probes targeting folate receptor alpha, mesothelin, and CA125 for improved intraoperative tumor visualization and surgical guidance.)* 25. Chang Y, et al. "Biomembrane-coated Nanoparticles Targeting circHIF1α Suppress Ovarian Cancer Metastasis and Cisplatin Resistance by Mediating System Xc⁻ Inactivation via SLC7A11/SLC3A2 to Induce Ferroptosis in Cancer Stem Cells." *International Journal of Biological Sciences.* May 18, 2026. PMID 42212330. *(Preclinical study using nanoparticle delivery to target a circular RNA that drives cisplatin resistance in ovarian cancer stem cells; combination with cisplatin showed synergistic antitumor effects in mice.)* 26. Wang JM, et al. "Reprogramming Transcriptional Networks via CREB1 Lactylation at K122 Activates HMGB1-Mediated NETosis and Chemoresistance." *International Journal of Biological Sciences.* May 18, 2026. PMID 42212318. *(Preclinical study identifying a lactate-driven epigenetic modification that enables cisplatin resistance in ovarian cancer; a targeted nanotherapy approach reversed resistance in mouse models.)* 27. Shao M, et al. "Artificial intelligence in ovarian cancer: advancing in precision diagnosis and clinical management." *Frontiers in Immunology.* May 7, 2026. PMID 42183263. *(Review of AI approaches applied to ovarian cancer imaging, digital pathology, and multi-omics for diagnosis, prognosis, and treatment response prediction.)* 28. Hou L, et al. "PARylation-centric crosstalk: orchestrating immune evasion and multidrug resistance in ovarian cancer." *Frontiers in Immunology.* May 1, 2026. PMID 42148103. *(Comprehensive review of how protein modifications including PARylation interact with immune evasion and PARP inhibitor resistance, with discussion of combination therapy strategies.)* 29. Hisa T, et al. "Trends and outcomes of surgical treatment for ovarian cancer in older adults in Japan." *Frontiers in Oncology.* May 4, 2026. PMID 42158412. *(Registry-based study of 1,365 patients aged ≥70 years in Japan; receipt of surgery was associated with longer overall survival, and use of non-surgical management increased over time in advanced disease.)* 30. Kuang M, et al. "Cytoreductive surgery for ovarian cancer with pelvic ectopic kidney: a case report." *Frontiers in Oncology.* May 15, 2026. PMID 42222411. *(Case report of successful cytoreductive surgery in a patient with ovarian cancer and a rare coexisting pelvic ectopic kidney, highlighting importance of multidisciplinary planning.)* --- **Papers Excluded Due to Licensing Restrictions** 31. Liu D, et al. "Genomic instability drives POSTNmyofibroblasts via STING-WNT axis to promote immunosuppression and PARPi resistance in ovarian cancer." *Science Translational Medicine.* May 27, 2026. PMID 42202048. *(Excluded: Proprietary publisher license (AAAS/Science). Topic: Preclinical and translational study revealing that genomic instability drives immunosuppression via stromal fibroblasts and PARP inhibitor resistance; POSTN blockade identified as potential therapeutic strategy.)* 32. Marchetti C, et al. "First-line immunotherapy with or without PARP inhibitors in advanced ovarian cancer: A meta-analysis including bevacizumab use, molecular status, and PD-L1 expression." *Critical Reviews in Oncology/Hematology.* May 18, 2026. PMID 42155872. *(Excluded: All rights reserved (Elsevier). Topic: Meta-analysis of 6 phase III trials (6,465 patients) finding no overall PFS benefit for immunotherapy ± PARPi in unselected patients, but potential benefit in HRD-positive BRCA wild-type and PD-L1-negative subgroups when combined with bevacizumab.)* 33. Oda K, et al. "Mutational Signature-Based Biomarker for Phase II Trial of Olaparib Maintenance in Advanced High-Grade Ovarian Cancer." *Cancer Science.* May 24, 2026. PMID 42178168. *(Excluded: Unconfirmed license (Wiley hybrid). Topic: Phase II trial validating a novel mutational signature-based HRD biomarker; olaparib maintenance showed 22.3-month median PFS in HRD-positive patients without bevacizumab.)* 34. Pishas KI, et al. "Identifying therapeutic targets in low-grade serous ovarian carcinomas with no specific molecular profile." *The Journal of Pathology.* May 15, 2026. PMID 42138099. *(Excluded: Unconfirmed license (Wiley hybrid). Topic: High-throughput drug screen identifying EGFR inhibitors as selective targets in low-grade serous ovarian carcinoma without MAPK mutations; EGFR expression associated with poor survival in this subtype.)* 35. Swisher EM, et al. "Homozygous Loss of Recombination Repair Genes and Poly ADP-Ribose Polymerase Inhibitor Benefit for Patients With Ovarian Cancer." *JCO Precision Oncology.* May 14, 2026. PMID 42133897. *(Excluded: CC BY-NC-ND. Topic: Real-world study showing patients with homozygous loss of HRR genes — a genomic alteration not always captured in routine testing — derive durable PARP inhibitor benefit, with median PFS of 25.4 months in monotherapy cohort.)* 36. Veneziani AC, et al. (same as ref 1 above for main trial; this entry is for any companion papers). — Not applicable. 37. Cui L, et al. "Targeting ADAR1 lactylation activates innate immune and overcomes chemoresistance in ovarian cancer." *Cell Death and Differentiation.* May 25, 2026. PMID 42185630. *(Excluded: Proprietary license (Springer/Nature exclusive licence). Topic: Preclinical study identifying ADAR1 lactylation as a driver of cisplatin resistance; a targeted inhibitor (ZYS-1) combined with cisplatin reduced tumor growth in mouse models.)* 38. Sehrawat A, et al. "Primary Platinum-Resistant Ovarian Cancer: Clinicopathologic Correlates and Outcomes From a Multicenter Prospective Indian Registry." *JCO Global Oncology.* May 27, 2026. PMID 42202250. *(Excluded: License not confirmed. Topic: Prospective multicenter Indian registry study finding primary platinum resistance in 16.9% of ovarian cancer patients, associated with advanced stage, poor performance status, and dismal survival outcomes.)* 39. Živić K, et al. "Validation of LOH-Germline Inference Calculator of Variant Origin on Real-World Data of Prevalence of Germline and Somatic BRCA Mutations in High-Grade Serous Ovarian Cancer in Serbia." *JCO Precision Oncology.* May 28, 2026. PMID 42208009. *(Excluded: License not confirmed. Topic: Real-world validation of a probabilistic model (LOHGIC) for inferring germline BRCA variant origin from tumor testing in 893 Serbian HGSOC patients; found model alone insufficient without clinical history.)* 40. Khawaja M. "Digital peer support and sexual well-being after gynaecological cancer." *Culture, Health & Sexuality.* May 20, 2026. PMID 42159507. *(Excluded: Unconfirmed license (Taylor & Francis). Topic: Qualitative thematic analysis of Reddit forums for gynecologic cancer; identified themes of sexual pain, body image, peer advice-seeking, and relational strain after diagnosis and treatment.)* 41. Lloyd-Ellis S, et al. "Uptake of risk-reducing medical interventions among female BRCA1/2 pathogenic variant carriers: A population-based study in British Columbia." *Gynecologic Oncology.* May 21, 2026. PMID 42166900. *(Excluded: Proprietary (Elsevier). Topic: Population-based study of 1,920 BRCA carriers in British Columbia; 71.8% underwent risk-reducing salpingo-oophorectomy, but late BRCA disclosure led to 24 potentially preventable ovarian cancers.)* 42. Shachar E, et al. "Real-world genetic testing data of ovarian cancer patients: Informing counseling and risk reduction in patients over age seventy." *Gynecologic Oncology.* May 11, 2026. PMID 42114202. *(Excluded: Proprietary (Elsevier). Topic: Analysis of 113,236 ovarian cancer patients in Myriad registry; 6.6% of patients ≥70 had actionable variants, often without family history that would prompt testing — supporting age-inclusive genetic testing.)* 43. Li L, et al. "Multigene germline testing for epithelial ovarian cancer in China." *Cancer.* May 1, 2026. PMID 42036915. *(Excluded: Proprietary (American Cancer Society/Wiley). Topic: Multicenter prospective cohort of 961 Chinese EOC patients; over 25% carried HR-related germline variants; BRCA1/2 carriers had better platinum response and survival.)* 44. Piacenti I, et al. "Risk, Prevalence and Survival Outcomes of Ovarian Cancer in Women with Endometriosis: The ENDOCANCER Systematic Review and Meta-Analysis." *Journal of Minimally Invasive Gynecology.* May 6, 2026. PMID 42102910. *(Excluded: All rights reserved (Elsevier). Topic: Systematic review and meta-analysis of >500,000 women; endometriosis doubled ovarian cancer risk (OR 1.82); endometriosis-associated ovarian cancers were earlier stage, lower grade, and had better survival.)* 45. Chiu PC, et al. "Development of a novel multimodal deep learning approach to improve diagnostic precision in ovarian cancer." *Briefings in Bioinformatics.* May 3, 2026. PMID 42089749. *(Excluded: Unconfirmed license (Oxford University Press hybrid). Topic: Multimodal deep learning combining ultrasound images with clinical text reports achieved 88.8% accuracy for distinguishing early-stage ovarian cancer from benign masses across external validation centers.)* 46. Ye M, et al. "Patient-derived ovarian cancer organoids as platforms for predicting platinum resistance and screening tumor stem cell inhibitors." *Drug Resistance Updates.* May 6, 2026. PMID 42128460. *(Excluded: Unconfirmed license (Elsevier). Topic: 191 patient-derived organoid models from 123 patients used to predict platinum sensitivity; organoids from primary tumors showed highest predictive accuracy; ALDH1A1 identified as stem cell marker and therapeutic target.)* 47. Jha P, et al. "Benign Lesions Scored as O-RADS US v2022 4 and 5 Categories: Prevalence and Morphologic Analysis." *Radiology.* May 2026. PMID 42117989. *(Excluded: Proprietary (RSNA). Topic: Multicenter retrospective study finding that among lesions scored as high-risk on ovarian ultrasound, 62% were benign; cystadenomas most common, with solid component the most frequent imaging feature in benign lesions.)* 48. Watanabe Y, et al. "Clinicopathological Status and Prognostic Factors of Recurrent Epithelial Ovarian Cancer in Japan: Retrospective Survey of JSOG Committee on Gynecologic Oncology." *Journal of Obstetrics and Gynaecology Research.* May 2026. PMID 42027044. *(Excluded: Unconfirmed license (Wiley). Topic: Retrospective Japanese multicenter survey of 443 recurrent EOC patients; platinum-free interval, histological subtype, performance status, and CA-125 identified as key prognostic factors; clear cell and endometrioid subtypes had worse outcomes than high-grade serous.)* 49. Cheng F, et al. "Efficacy and Safety of Pamiparib Monotherapy in Recurrent Ovarian Cancer After Prior PARPi Exposure: A Phase II Study." *Journal of Obstetrics and Gynaecology Research.* May 2026. PMID 42051038. *(Excluded: Unconfirmed license (Wiley). Topic: Phase II trial of pamiparib re-treatment after prior PARPi exposure; 26.7% clinical benefit rate, suggesting limited efficacy for single-agent PARP re-treatment.)* 50. De Vincentis S, et al. "Association between risk-reducing salpingooophorectomy and bone health in women with hereditary breast and ovarian cancer syndrome." *Menopause.* May 12, 2026. PMID 42118531. *(Excluded: Unconfirmed license (Wolters Kluwer). Topic: Longitudinal observational study finding RRSO without hormone therapy associated with progressive bone loss and increased fracture risk; HRT mitigated these effects.)* 51. Telles R, et al. "Rethinking depression diagnosis in ovarian cancer: The role of somatic symptoms." *Cancer.* May 15, 2026. PMID 42108834. *(Excluded: Unconfirmed license (Wiley/American Cancer Society). Topic: Study of 428 patients showing that somatic symptoms may inflate depression screening scores at diagnosis, potentially leading to overestimation of depression severity; differences resolved by one year.)* 52. Lee SS, et al. "A novel surname-based methodology to improve the disaggregation of Asian American ethnic subgroups in patients with ovarian cancer." *Gynecologic Oncology Reports.* May 15, 2026. PMID 42211240. *(Excluded: Unconfirmed license (Elsevier). Topic: Methodological study showing that combining self-reported race/ethnicity with surname-based analysis improved Asian American ethnic subgroup disaggregation in ovarian cancer patient data.)* 53. Karimaghaie T, et al. "Navigating the healthcare system with a BRCA pathogenic variant: What do patients value?" *Gynecologic Oncology Reports.* May 9, 2026. PMID 42199934. *(Excluded: Unconfirmed license (Elsevier). Topic: Patient preference survey of 27 BRCA variant carriers; strong preference for centralized care at a single institution with expertise across cancer screening, risk-reducing surgery, and menopause management.)* 54. Iida Y, et al. "Durable complete remission of pulmonary metastases with bevacizumab plus olaparib maintenance therapy in homologous recombination-deficient gynecologic large-cell neuroendocrine carcinoma: A case report." *Gynecologic Oncology Reports.* May 19, 2026. PMID 42199932. *(Excluded: Unconfirmed license (Elsevier). Topic: Case report of complete remission with bevacizumab plus olaparib in an HRD-positive (no BRCA mutation) gynecologic neuroendocrine carcinoma; suggests PARP inhibitor benefit may extend to rare HRD-positive tumor types.)* 55. Zhou X, et al. "Hematological toxicities in bevacizumab associated with ovarian cancer: A pharmacovigilance study using FDA adverse event reporting system database." *Medicine (Baltimore).* May 15, 2026. PMID 42152360. *(Excluded: Unconfirmed license (Wolters Kluwer). Topic: FDA FAERS analysis finding bevacizumab associated with hematological toxicities — including rare events not on the drug label — with median time to onset of 30 days and 16% fatality rate in reported hematotoxicity cases.)* 56. Li XT, et al. "Clinical analysis of postoperative intestinal dysfunction in patients with advanced epithelial ovarian cancer." *Zhonghua Yi Xue Za Zhi.* May 19, 2026. PMID 42135051. *(Excluded: License not confirmed. Topic: Retrospective study of 275 patients identifying risk factors for postoperative bowel dysfunction (PPOI and LARS) after cytoreductive surgery; poor nutritional status and pelvic peritonectomy were key risk factors.)* 57. Wang Y, et al. "VEGF/VEGFR targeting-induced vascular normalization: a key strategy to reverse cold tumor phenotype and potentiate immunotherapy in gynecologic cancers." *International Immunopharmacology.* May 13, 2026. PMID 42127491. *(Excluded: Unconfirmed license (Elsevier). Topic: Review of VEGF/VEGFR inhibitor + checkpoint inhibitor combinations for converting immunologically "cold" gynecologic cancers to "hot" tumors responsive to immunotherapy.)* 58. Nie S, et al. "Targeting lactate with a GLUT1 inhibitor reverses PARP inhibitor resistance in ovarian cancer." *Acta Biochimica et Biophysica Sinica.* May 26, 2026. PMID 42212621. *(Excluded: License not confirmed. Topic: Preclinical study finding that blocking glucose uptake via GLUT1 inhibition restores olaparib sensitivity in resistant ovarian cancer cells by reducing lactate and impairing DNA repair.)* 59. Ndeke D, et al. "DHX37 protein and mRNA expression patterns in breast and ovarian cancer and their prognostic implications." *Histochemistry and Cell Biology.* May 18, 2026. PMID 42151440. *(Excluded: Unconfirmed license (Springer hybrid). Topic: Study of 420 ovarian cancer cases finding that low DHX37 expression is paradoxically associated with improved survival — contrasting with its role in breast cancer — suggesting context-dependent biological functions.)* 60. He S, et al. "Integrative Genomic and Functional Analysis Reveals NF1 Loss as a Modifier of DNA Damage and Replication Stress Responses in Ovarian Cancer." *Human Mutation.* May 18, 2026. PMID 42158468. *(Excluded: Unconfirmed license (Wiley). Topic: TCGA analysis and functional study showing NF1 loss in ovarian cancer is associated with distinct DNA damage signatures and increased vulnerability to replication stress.)* 61. Wang L, et al. "Nanomedicines from the patient perspective — 30 years after PEGylated liposomal doxorubicin." *Journal of Controlled Release.* May 20, 2026. PMID 42167367. *(Excluded: Unconfirmed license (Elsevier). Topic: Perspective on the legacy of liposomal doxorubicin (a common ovarian cancer treatment), arguing that patient-centered outcomes like tolerability and "time toxicity" are systematically undervalued in nanomedicine evaluation.)* 62. Pighi C, et al. "Exploring alternatives to tumor tissue for BRCA1/2 next-generation sequencing testing in high-grade serous ovarian cancer: A 34-case series of malignant ascites." *Cancer Cytopathology.* May 2026. PMID 42046206. *(Excluded: Unconfirmed license (Wiley/American Cancer Society). Topic: Case series showing 100% concordance between BRCA testing from ascites fluid versus surgical tissue specimens, supporting ascites as a minimally invasive alternative for BRCA testing in HGSOC.)* 63. Alzayadneh E, et al. "HER2 and FOLR1 Expression in Mesonephric and Mesonephric-Like Adenocarcinomas in the Gynecologic Tract." *International Journal of Gynecological Pathology.* May 7, 2026. PMID 42095344. *(Excluded: Unconfirmed license (Wolters Kluwer). Topic: Immunohistochemical study of 21 rare mesonephric/mesonephric-like adenocarcinomas; most did not meet current thresholds for trastuzumab deruxtecan or mirvetuximab monotherapy, but detectable expression supports exploring combination approaches.)* 64. Nasdala A, et al. "Reduced folate receptor alpha (FOLR1) protein expression in fallopian tubes from premenopausal women: implications for the FOLR1 CDx assay for mirvetuximab-soravtansine therapy." *The Journal of Pathology: Clinical Research.* May 2026. PMID 42023640. *(Excluded: Unconfirmed license (Wiley). Topic: Pathology study showing fallopian tube FOLR1 expression varies by menopausal status; recommends postmenopausal fallopian tube tissue as the optimal on-slide control for the MIRV companion diagnostic assay.)* 65. Taji T, et al. "Real-world uptake of gBRCA testing as a companion diagnostic for olaparib in patients with high-risk HER2-negative early breast cancer in Japan." *Breast Cancer.* May 23, 2026. PMID 42176176. *(Excluded: Unconfirmed license (Springer hybrid). Topic: Real-world study finding only 63% of eligible breast cancer patients in Japan underwent gBRCA testing; physician awareness gaps were the leading cause of untested patients.)* 66. Kano M, et al. "Prevalence and clinical significance of germline pathogenic variants identified by multigene panel testing in high-risk Japanese patients with breast cancer." *Breast Cancer.* May 13, 2026. PMID 42126782. *(Excluded: Unconfirmed license (Springer hybrid). Topic: Multigene panel testing in 494 high-risk Japanese breast cancer patients found 9.1% overall pathogenic variant rate, including non-BRCA genes; supports broader testing panels.)* 67. Uekusa R et al. — (same as ref 10 above; see directly referenced section). — Not a duplicate. 68. Miyamoto E, et al. "Changes in Epithelial Ovarian Cancer Treatment and Advent of Maintenance Therapy From Real-World Data." *Journal of Obstetrics and Gynaecology Research.* May 2026. PMID 42134975. *(Excluded: Unconfirmed license (Wiley). Topic: Analysis of 2,824 Japanese patients (1986–2019) showing improved five-year overall survival over time, particularly in advanced-stage serous and endometrioid subtypes; younger patients showed a trend but not significant improvement.)* 69. Lilli L, et al. "From Report to Record: Prompt-Based Information Extraction from Gynecology Oncology Reports Using LLMs." *Studies in Health Technology and Informatics.* May 21, 2026. PMID 42174970. *(Excluded: License not confirmed. Topic: Framework using large language models to extract structured clinical information from Italian multidisciplinary tumor board reports for ovarian cancer.)* 70. Li Y, et al. "ZDHHC14-driven RUNX2 S-palmitoylation attenuates ferroptosis and enhances chemoresistance in ovarian cancer via the YAP1/GLS1 axis." *Apoptosis.* May 18, 2026. PMID 42149203. *(Excluded: Unconfirmed license (Springer hybrid). Topic: Preclinical study identifying palmitoylation of RUNX2 as a mechanism of ferroptosis resistance and cisplatin resistance in ovarian cancer.)* 71. Wang L et al. "BRCA1P1 pseudogene" — See ref 21 above. 72. Jiang Y, et al. "Knockout of filamin A in KGN granulosa tumor cells impairs proliferation, cell cycle progression, migration, and cytoskeletal organization under mechanical stress." *Biological Research.* May 20, 2026. PMID 42163310. *(Excluded: Unconfirmed license (BioMedCentral hybrid — license not explicitly confirmed via copyright check). Topic: Preclinical study of filamin A protein's role in granulosa cell tumor proliferation and migration under mechanical stress.)*

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