Engineering immune-competent niches: strategies, applications, and translational hurdles in ovarian cancer organoid models

Ovarian cancer remains the most lethal gynecologic malignancy due to strong interpatient heterogeneity and immune evasion. Traditional two-dimensional cultures and animal models lack the ability to maintain interactions among tumors, immune cells, and stromal cells and have limitations in clinical translation. This review discusses the organoid construction methods using adult stem cells (normal epithelium, tumor tissues and ascites), and induced pluripotent stem cells, comparing various culture platforms from air–liquid interface to microfluidic devices. We highlight organoids containing immune components are valuable for assessing T cell exhaustion, NK cell cytotoxicity, and stromal communication, which help to screen immunotherapy, discover biomarker, and profile drug resistance. The persistent challenges include limited vascularization, short-term maintenance of immune components and lack of standard protocols. We present new solutions that integrate multi-omics, biomaterials and automated perfusion to improve physiological fidelity and scalability. Collectively, ovarian cancer organoids with immune microenvironment can bridge preclinical gaps and accelerate the development of personalized immune therapy.