Advancing Ovarian Cancer Therapy in China: Insights From Research and Practices

Ovarian cancer is a major health burden in China. Over the past three decades, the burden of ovarian cancer has significantly increased, and in the next decade, it is expected to keep increasing at a rate higher than the global average [1]. The 5-year survival rate of patients with ovarian cancer in China has been approximately 40% with no improvement [2]. With robust support from the Chinese government, several gynaecological oncology committees have recently made unprecedented efforts to improve the 5-year survival rate by promoting screening technologies, accelerating the construction of a gynaecological oncology specialist system, and enhancing awareness of standardised diagnosis and treatment, as well as the whole process management. In this special issue of BJOG, we have selected seven manuscripts focusing on poly (ADP-ribose) polymerase (PARP) inhibitors, chemotherapy, and surgery for ovarian cancer in China, showing the significant progress China has made in the treatment of ovarian cancer.

The advent of PARP inhibitors has been a significant milestone in the pharmacological treatment of ovarian cancer. Since 2017, many clinical registration studies for Chinese patients with ovarian cancer have been conducted to investigate the efficacy and safety of PARP inhibitor maintenance therapy [3-8]. The results of these studies have provided strong evidence to support the clinical application of PARP inhibitors. Xie and Shao et al. have, respectively, provided comprehensive summaries of data from clinical trials and real-world studies of PARP inhibitors for first-line and platinum-sensitive recurrent (PSR) maintenance in China. Moreover, Xie et al. analysed the differences in patient characteristics and safety data between Chinese and international studies in their review of first-line maintenance and proposed maintenance strategies for patients with different biomarker statuses based on the current status of first-line maintenance in China. In their review of PSR maintenance, Shao et al. elucidated the safety issues resulting from the long-term use of PARP inhibitors and discussed the differences in indications for PARP inhibitors between China and abroad.

As PARP inhibitors are widely used, drug resistance is inevitable. Chinese researchers and physicians are exploring ways to overcome this and evaluating the potential for PARP inhibitor rechallenge. Zhou et al. established a niraparib-resistant BRCA wild-type ovarian cancer cell line and found that the combination of CDK4/6 inhibitor TQB-3616 and niraparib could effectively inhibit the growth of ovarian cancer cells and reverse resistance. EndoG nuclear translocation might be the key mechanism for synergy. Li et al. evaluated the efficacy of PARP inhibitor rechallenge as a maintenance therapy in a real-world setting and revealed that using a combination regimen and achieving complete remission might be associated with a good prognosis. A real-world study by Zhang et al. showed that PARP inhibitors combined with anti-angiogenic agents are a potential treatment option for patients with no ascites and a low tumour burden who have disease progression after PARP inhibitor maintenance therapy, without negative effects on subsequent chemotherapy.

Previously, PARP inhibitors were approved for ovarian cancer maintenance therapy in China. Zheng et al. developed a maintenance strategy called adjuvant chemotherapy of three steps (ACTS) and established the ‘YNCBWR1’ standard to identify patients who could benefit from ACTS in terms of survival, especially for patients without BRCAm or HRD. Now that PARP inhibitor-based maintenance has become the standard of care for ovarian cancer, ACTS may not be a promising maintenance therapy.

For ovarian cancer patients who developed PSR after initial treatment, secondary cytoreductive surgery (SCS) has been shown to prolong progression-free survival (PFS) in patients with R0 resection [9-11]. However, its efficacy in patients with later recurrences is unclear. A multicentre retrospective study by Zhao et al. showed that patients with second PSR who underwent SCS had similar overall survival and PFS2 to patients who underwent SCS for their first PSR, and the incidence of surgical complications was acceptable.

China is the most populous country in the world and has the largest population requiring gynaecological oncology services, posing a significant challenge to the healthcare system. We sincerely hope that the publication of this special issue will provide a new impetus for the improvement of standardised diagnosis and treatment of ovarian cancer in China, stimulate further research, promote the accumulation of real-world data, and contribute to improving the 5-year survival rate of ovarian cancer in China.

The author declares no conflicts of interest.