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Opinion|Videos|May 5, 2025

Emerging Molecular Biomarkers in Ovarian Cancer

A panelist discusses how multiple molecular biomarkers beyond BRCA and homologous recombination deficiency (HRD) testing are emerging as important for guiding ovarian cancer therapy, including microsatellite instability (MSI), tumor mutational burden (TMB), HER2, p53, KRAS, and CCNE amplification.

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Emerging Molecular Biomarkers Beyond BRCA/HRD

Several important biomarkers guide ovarian cancer treatment beyond BRCA and HRD:

Tumor-agnostic biomarkers:

  • MSI/mismatch repair deficiency and TMB: Predict response to immunotherapy
  • HER2 (immunohistochemistry): Approved April 2024 for trastuzumab deruxtecan (FDA approved for 3+ expression; National Comprehensive Cancer Network recommends for 2+ also)

Diagnostic and predictive biomarkers:

  • p53: Distinguishes high-grade from low-grade serous ovarian cancer
  • KRAS: Expected to become an integrated biomarker for upcoming MEK/FAK inhibitor combination therapy in low-grade serous ovarian cancer
  • CCNE1 amplification: Mutually exclusive with BRCA mutations, associated with platinum resistance, with targeted therapies in development

The field continues to advance through collaborative research networks, including GOG Foundation and ENGOT, developing biomarker-directed treatments for gynecologic cancers.

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