Role of the tumor microenvironment in chemotherapy resistance in ovarian cancer and targeted therapy

Ovarian cancer is currently the gynaecological malignancy with the highest mortality rate, with a five-year survival rate of less than 50%. Combination chemotherapy regimens primarily based on platinum remain the main treatment for advanced ovarian cancer. However, while most patients initially respond sensitively to chemotherapy drugs, approximately 80% of patients develop resistance to chemotherapy drugs after repeated cycles of chemotherapy. Chemotherapy resistance is a key reason for treatment failure in patients with advanced ovarian cancer or recurrent ovarian cancer. There are many reasons for chemotherapy resistance in ovarian cancer patients, with tumor microenvironment emerging as a key focus. This "neighbor" has previously been regarded as a bystander during tumor initiation and growth. Through technological advances and deeper research, tumor microenvironment is now recognized as a critical active contributor to cancer progression, as well as chemotherapy resistance. Therefore, this paper reviews the research progress on the cellular and non-cellular components in the tumor microenvironment that contribute to chemotherapy resistance in ovarian cancer. Furthermore, we reviewed the impact of chemotherapy resistance from the perspectives of tumor hypoxia and tumor energy metabolism. Summarized the latest strategies for targeted tumor microenvironment therapy. With the aim of improving the prognosis of ovarian cancer patients, reversing chemotherapy resistance, and identifying drug treatment targets in the tumor microenvironment, this study provides new insights.