Advances in Phase III Clinical Trials and Future Challenges of Targeted Therapy in Advanced Ovarian Cancer

Abstract: Advanced ovarian cancer (OC) is characterized by an insidious onset, a high recurrence rate, and complex mechanisms of drug resistance, and has long been associated with poor prognosis, representing one of the leading causes of cancer-related death among women worldwide. In recent years, rapid advances in molecular biology and translational medicine have markedly transformed the therapeutic landscape of advanced ovarian cancer. Targeted therapies, including bevacizumab-based anti-angiogenic therapy, PARP inhibitors, and antibody–drug conjugates, act on key oncogenic pathways involved in tumor angiogenesis, DNA damage repair, and tumor-specific antigens, and have significantly prolonged PFS, with OS benefits observed in selected patient populations. This review systematically summarizes the major mechanisms underlying targeted therapy in advanced ovarian cancer and highlights the key evidence and clinical value of these three major classes of targeted agents in phase III clinical trials. By integrating mechanistic insights with phase III clinical evidence, this review further proposes that future research should focus on the evolution of therapeutic resistance, long-term safety management, standardized biomarker testing, and the optimization of combination and sequential treatment strategies. With the continued refinement of predictive biomarkers, improvement of multi-target combination approaches, and development of novel targeted agents, further gains in survival and quality of life are anticipated for patients with advanced ovarian cancer. Keywords: advanced ovarian cancer, targeted therapy, phase iii clinical trials