Advances in immunotherapies in ovarian cancer

Ovarian cancer (OC) remains one of the deadliest gynecologic malignancies, and, despite the presence of tumor-infiltrating lymphocytes (TILs) in nearly half of cases, immune checkpoint inhibitors have shown only modest clinical benefit. These observations have stimulated interest in antigen-directed immunotherapies, including adoptive cell therapies (chimeric antigen receptor T cell, TIL therapy), bispecific antibodies, cancer vaccines, cytokine-based agents, and antibody–drug conjugates. Multiple targets, such as mesothelin, folate receptor-α, HER2, MUC16, EpCAM, and claudin-6, are currently under clinical investigation. In this review, we summarize the current landscape of immunotherapy in OC and examine the biological and clinical factors that have limited therapeutic efficacy to date. We also discuss emerging strategies aimed at overcoming resistance, including rational combinations and biomarker-driven approaches. Finally, we highlight the critical role of integrated genomic and immune profiling to elucidate mechanisms of response and resistance and to guide the next generation of immunotherapeutic strategies for OC.