Cancer Genetics and Epigenetics 2025, Vol.13 http://medscipublisher.com/index.php/cge © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved.
Cancer Genetics and Epigenetics 2025, Vol.13 http://medscipublisher.com/index.php/cge © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved. MedSci Publisher is an international Open Access publisher specializing in cancer genetics, cancer epigenetics, clinical pharmacology, cancer biology at the publishing platform that is operated by Sophia Publishing Group (SPG), founded in British Columbia of Canada. Publisher MedSci Publisher Editedby Editorial Team of Cancer Genetics and Epigenetics Email: edit@cge.medscipublisher.com Website: http://medscipublisher.com/index.php/cge Address: 11388 Stevenston Hwy, PO Box 96016, Richmond, V7A 5J5, British Columbia Canada Cancer Genetics and Epigenetics (ISSN 2369-2995) is an open access, peer reviewed journal published online by MedSci Publisher. The journal is aimed to publish all works in the areas that with quality and originality, with a scope that spans the areas of cancer genetics and cancer epigenetics. It is archived in LAC (Library and Archives Canada) and deposited in CrossRef. The journal has been indexed by ProQuest as well, expected to be indexed by PubMed and other datebases in near future. All the articles published in Cancer Genetics and Epigenetics are Open Access, and are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. MedSci Publisher uses CrossCheck service to identify academic plagiarism through the world’s leading plagiarism prevention tool, iParadigms, and to protect the original authors’ copyrights.
Cancer Genetics and Epigenetics (online), 2025, Vol. 13, No. 2 ISSN 2369-2995 http://medscipublisher.com/index.php/cge © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved. Latest Content Application of Personalized Treatment in the Comprehensive Management of Advanced Ovarian Cancer and Assessment of Its Clinical Value YongCheng Cancer Genetics and Epigenetics, 2025, Vol. 13, No. 2, 50-61 Genomic Insights into the Pathogenesis of Esophageal Adenocarcinoma Tiantian Li, Jie Zhang Cancer Genetics and Epigenetics, 2025, Vol. 13, No. 2, 62-76 Role of Histone Modifications in Prostate Cancer Liqin Guo, Jiayi Wu Cancer Genetics and Epigenetics, 2025, Vol. 13, No. 2, 77-89 Intraoperative Risk Management and Postoperative Recovery Strategies for Cervical Cancer Patients MinLi Cancer Genetics and Epigenetics, 2025, Vol. 13, No. 2, 90-97 Prospects of Multimodal Imaging Techniques in Oral Cancer Diagnosis ManmanLi Cancer Genetics and Epigenetics, 2025, Vol. 13, No. 2, 98-105
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 50 Review Article Open Access Application of Personalized Treatment in the Comprehensive Management of Advanced Ovarian Cancer and Assessment of Its Clinical Value YongCheng Physicov. Med. Tech. Ltd., Zhejiang, Zhuji, 311800, Zhejiang, China Corresponding email: 2741098603@qq.com Cancer Genetics and Epigenetics, 2025, Vol.13, No.2 doi: 10.5376/cge.2025.13.0006 Received: 10 Jan., 2025 Accepted: 21 Feb., 2025 Published: 07 Mar., 2025 Copyright © 2025 Cheng, This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Preferred citation for this article: Cheng Y., 2025, Application of personalized treatment in the comprehensive management of advanced ovarian cancer and assessment of its clinical value, Cancer Genetics and Epigenetics, 13(2): 50-61 (doi: 10.5376/cge.2025.13.0006) Abstract This study analyzed the approaches of integrating individualized treatment into the comprehensive management of advanced ovarian cancer and measured its clinical value. The study described the molecular and cellular characteristics of advanced diseases, as well as the core individualized treatment approaches-covering the application of genetic testing, immune checkpoint inhibitors, and novel therapies (such as antibody-drug conjugates and cancer vaccines) in the selection of targeted drugs. This study explored how to integrate individualized treatment with chemotherapy, surgery and radiotherapy within the framework of a multidisciplinary team, with a focus on the arrangement of treatment timing and strategies for synergistic enhancement. It also evaluated safety data, health economics evaluations and quality of life outcomes, emphasizing the necessity of effectively managing adverse reactions and cost considerations. Individualized treatment has revolutionized the treatment model of advanced ovarian cancer, improving the therapeutic effect and reducing toxic and side effects. However, in-depth research is still needed to establish standardized biomarker detection, optimize combined treatment strategies, and ensure accessibility for patients in different medical Settings. Keywords Advanced ovarian cancer; Personalized therapy; PARP inhibitors; Immune checkpoint inhibitors; Biomarkers 1 Introduction Most advanced ovarian cancers are discovered at a relatively late stage and are gynecological malignancies with a very high fatality rate. The conditions of most patients were not optimistic when they were diagnosed (Konstantinopoulos and Matulonis, 2023; Tavares et al., 2024). Due to the lack of effective screening methods and reliable judgment indicators, it is difficult to detect the disease at an early stage and make an accurate diagnosis. Moreover, the types of this kind of cancer are diverse and it is prone to develop resistance to chemotherapy drugs, which makes the long-term control of the disease even more difficult. Therefore, patients often experience a repeated process of improvement and recurrence of their condition. To predict the treatment outcome of each patient and formulate an effective treatment plan has always been a major clinical challenge (Phloem, 2011; Cortez et al., 2017; Tavares et al., 2024). In the past, the standard treatment for advanced ovarian cancer was mainly to perform cytoreductive surgery first and then carry out platinum-based chemotherapy (Nick et al., 2015; Bookman, 2016; Konstantinopoulos and Matulonis, 2023). Although these treatment methods can show effects at the beginning, the conditions of most patients will eventually relapse, and the overall survival situation is not ideal (Bookstore, 2016; Cortez et al., 2017). The conventional treatment has a poor effect because it cannot solve the problems of complex variability and drug resistance of tumors, and it also brings obvious side effects (Tavares et al., 2024). In addition, the current methods for assessing the condition and formulating surgical plans before surgery are not precise enough, often resulting in incomplete tumor resection during the operation and unstable postoperative recovery of patients (Nick et al., 2015). Due to the lack of personalized treatment plans, many patients can only receive a "one-size-fits-all" uniform treatment, which may not be in line with the characteristics of their own tumors and their responses to drugs, further affecting the treatment effect (Phloem, 2011; Garbuzenko et al., 2024). This study will explore the practical application of personalized treatment in the comprehensive treatment of advanced ovarian cancer, evaluate its clinical value, and also analyze the difficulties encountered in the early
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 51 detection and disease diagnosis of advanced ovarian cancer. It will study the shortcomings of traditional chemotherapy and surgical treatment, and explore new directions for personalized and precise treatment, such as genetic testing, customized surgical plans, and new drug delivery techniques. Clarifying these methods can influence the treatment outcome of patients and the future development trend of personalized treatment. 2 Molecular Biological Characteristics of Advanced Ovarian Cancer 2.1 Common gene mutations In the pathogenesis of advanced ovarian cancer, gene mutations play a key role, among which the mutations of the two genes BRCA1 and BRCA2 are particularly important. These gene mutations can cause functional defects in homologous recombination repair, making it difficult for cells to repair broken double-stranded DNA, and also making tumors more sensitive to targeted therapeutic drugs such as PARP inhibitors (Figure 1) (Lheureux et al., 2019; Colombo et al., 2024). High-grade serous ovarian cancer is the most common type. This type of cancer often has TP53 gene mutations, which can lead to genetic instability and cause the tumor to deteriorate continuously (Hollis and Gourley, 2016; Lheureux et al., 2019; Hollis, 2023). Figure 1 Illustration of clinical features associated with BRCA1/2 mutations in advanced high-grade serous ovarian cancer: advanced disease at presentation and rapid progression (Adopted from Colombo et al., 2024) Image caption: C: advanced ovarian cancer diagnosed in a 40 year-old patient with a germline BRCA1 gene mutation; Figure 1 C1, C2, C3 and C4: CT-scan, PET-scan and diagnostic laparoscopy revealed an extended peritoneal carcinomatosis despites the patient had undergone prophylactic adnexectomy 4 months earlier; During this prophylactic surgery, no extension to the peritoneum was observed with normal adnexa on histological examination; Patient was treated with neoadjuvant chemotherapy and interval cytoreductive surgery. Patient is still receiving maintenance treatment with olaparib and bevacizumab; D: rapid progression of a peritoneal carcinomatosis in a 35-year-old patient with a BRCA1 germline mutation; Figs. D1, D2, D3 and D4: Significant progression of the ovarian mass and peritoneal implants was observed between initial MRI and complementary CT-scan MRI, even though these examinations are only 15 days apart; Patient was treated with neoadjuvant chemotherapy and interval cytoreductive surgery; Patient is still receiving maintenance treatment with olaparib and bevacizumab (Adopted from Colombo et al., 2024) The situation of BRCA1/2 gene mutations and homologous recombination for repairing functional defects not only affects the therapeutic effect, but also is related to the surgical plan and the recovery of patients (Lheureux et al., 2019; Garsed et al., 2022; Colombo et al., 2024). For instance, for patients carrying BRCA1/2 gene mutations, maintenance treatment with PARP inhibitors may have a better effect, and the growth characteristics of their tumors are also different compared with those without these mutations (Colombo et al., 2024; Garsed et al., 2022). Understanding these genetic changes is crucial for formulating treatment plans suitable for each patient and improving the treatment effect (Hollis and Gourley, 2016; Lheureux et al., 2019; Colombo et al., 2024). 2.2 Clinical significance of different molecular subtypes Ovarian cancer is not a single disease. It encompasses a variety of different tissue types and molecular types, and the manifestations and patient recovery conditions of each type are different (Rojas et al., 2016; Hollis and
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 52 Gourley, 2016; Hollis, 2023). There are mainly five types of tissues, namely high-grade serous, endometrioid, clear cell, mucous and low-grade serous. Now the medical community has confirmed that, from the clinical and molecular levels, they all belong to different diseases (Hollis and Gourley, 2016; Hollis, 2023). Through the study of molecular characteristics, different subgroups can be further subdivided among these tissue types, and the differences in genetic changes, treatment responses and survival conditions can be discovered (Rojas et al., 2016; Hollis and Gourley, 2016; Hollis, 2023). This molecular difference is important for the treatment of patients because for cases like clear cell carcinoma and mucinous ovarian cancer, conventional chemotherapy is not very effective and other treatment methods need to be adopted (Hollis, 2023; Tong et al., 2023). Nowadays, more and more patients are classified based on their molecular characteristics to select appropriate targeted treatment regimens and assess recovery conditions. However, there are still many difficulties in applying these research results to daily clinical treatment (Hollis and Gourley, 2016; Bukłaho et al., 2023). 2.3 Mechanisms of key signaling pathways In advanced ovarian cancer, several core signaling pathways often experience dysfunction. These abnormalities drive tumor progression and induce therapeutic resistance. DNA damage repair pathways, especially the parts involving BRCA1/2 genes and homologous recombination repair, have become the research focus due to regulating the sensitivity of tumors to targeted drugs such as PARP inhibitors (Lheureux et al., 2019; Colombo et al., 2024). Furthermore, alterations in the TP53 pathway trigger uncontrolled cell proliferation, resulting in genomic instability. This phenomenon is particularly common in high-grade serous carcinoma (Hollis and Gourley, 2016; Hollis, 2023; Lheureux et al., 2019). Other pathways, such as signal networks that regulate angiogenesis, cell survival and the tumor microenvironment, also play key roles in disease progression and drug resistance formation (Mok et al., 2009; Rojas et al., 2016; Schoutrop et al., 2022). For example, the high expression of the angiogenic factor MAGP2 often indicates a poor prognosis for patients and an increase in tumor vascular density. Clarifying the molecular mechanisms of these pathways is crucial for discovering new therapeutic targets and formulating efficient individualized regimens (Rojas et al., 2016; Schoutrop et al., 2022). 3 Strategies for Personalized Treatment 3.1 Principles for targeted drug selection based on genomic testing Genetic testing is becoming increasingly crucial for selecting targeted drugs for advanced ovarian cancer. With the help of this test, doctors can determine which patients are more suitable for specific treatment methods based on the molecular characteristics of the tumor. Just like the gene expression analysis model, it can accurately determine whether patients are resistant to platinum-based chemotherapy drugs and help doctors quickly identify those patients who need to switch or add other targeted drugs (Dressman et al., 2007; Zhou, 2024). Moreover, this kind of detection can also identify oncogenic pathways such as Src and Rb/E2F that are in an active state. Treating with drugs targeting these pathways can improve the therapeutic efficacy of platinum-resistant patients (Dressman et al., 2007). Applying the results of genomic testing to clinical treatment decisions makes treatment plans more tailored to the individual conditions of patients, changing the past "one-size-fits-all" treatment model. Doctors select targeted therapies such as PARP inhibitors or anti-angiogenic drugs based on the unique genetic changes of each patient's tumor, which can not only improve the therapeutic effect but also reduce unnecessary side effects (Cortez et al., 2017; Nakai and Matsumura, 2022). This precise treatment approach is changing the treatment pattern of advanced ovarian cancer, bringing better treatment outcomes and longer survival periods to patients (Dressman et al., 2007). 3.2 Application and characteristics of immune checkpoint inhibitors Immune checkpoint inhibitors provide a new treatment approach for advanced ovarian cancer. This type of drug can enhance the body's ability to recognize and clear cancer cells. They specifically act on immune signaling
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 53 pathways such as PD-1/PD-L1 and are currently undergoing clinical trial evaluations. To overcome the immunosuppressive microenvironment of tumors, these drugs are usually used in combination with other therapies (Cortez et al., 2017; Konstantinopoulos and Matulonis, 2023). Although immune checkpoint inhibitors have enabled long-term control of the condition in some patients, the overall effective rate is not ideal. This indicates that more precise screening of applicable patients is still needed, and better combined treatment regimens need to be explored (Konstantinopoulos and Matulonis, 2023). At present, relevant research focuses on finding biomarkers that can predict therapeutic effects and optimizing the application of such drugs in personalized treatment, with the goal of enabling patients with advanced ovarian cancer to achieve stable and long-lasting therapeutic effects (Cortez et al., 2017). 3.3 Emerging therapies New therapies such as antibody-drug conjugates (ADCs) and cancer vaccines have expanded the options for individualized treatment of advanced ovarian cancer. ADC precisely delivers potent cytotoxic drugs to cancer cells through the targeted characteristics of monoclonal antibodies. This strategy achieves selective killing of drugs and reduces toxicity to normal tissues. This targeted delivery method has shown advantages in the treatment of advanced, metastatic or recurrent patients, which helps to overcome drug resistance and improve therapeutic efficacy (Wang et al., 2021). The cancer vaccine is a brand-new treatment method. Its working mode is to present tumor-related substances to the human immune system, prompting the immune system to actively recognize and eliminate ovarian cancer cells (Akter et al., 2022). At present, most cancer vaccines are still in the research and trial stage, but they play a significant role. Especially when used in combination with other immunotherapy methods and targeted drugs, they can enhance the immune system's surveillance of tumors and reduce the possibility of cancer recurrence. When these treatment methods are developed more perfectly, the current deficiencies in treatment can be addressed, and the level of personalized treatment for advanced ovarian cancer can be greatly improved (Wang et al., 2021). 4 Biomarkers and Patient Selection 4.1 The predictive effect of BRCA mutations on HRD scores Mutations in the BRCA1/2 gene are the core factor leading to abnormal homologous recombination repair function in patients with ovarian cancer. This situation is of great significance when carrying out personalized treatment. If BRCA gene mutations are detected in patients or their HRD scores are relatively high, it often means that the therapeutic effect of using platinum-based chemotherapy drugs and PARP inhibitors will be better for them. Therefore, by detecting these indicators, doctors can more accurately select patients suitable for treatment with such targeted drugs. Nowadays, whether it is for the treatment of advanced ovarian cancer or the management of recurrent ovarian cancer, checking the BRCA gene and HRD status is something that must be done when formulating the treatment plan (Chastek et al., 2021; Tonti et al., 2024). Although very useful, there is currently a lack of effective and commonly used HRDgene detection methods, and there are no clear treatment plans that rely entirely on these markers (Tonti et al., 2024). However, the use of BRCA and HRD tests has significantly increased and they have begun to be used in earlier treatment stages, which is in line with the trend of making the treatment of advanced ovarian cancer more individualized and effective (Chastek et al., 2021). 4.2 The value of immune-related markers Studies have found that immune indicators such as PD-L1 expression level and tumor mutational burden (TMB) may predict the therapeutic effect of patients with advanced ovarian cancer after using immune checkpoint inhibitors (Na et al., 2024). Especially for patients with high PD-L1 expression levels, the effect is often better after using immunotherapy. Detecting this indicator can help doctors identify which patients are more suitable for using this type of drug. By the same token, patients with high TMB levels are more likely to respond to immunotherapy. However, the specific role it plays in the treatment of ovarian cancer is still under further study.
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 54 When selecting patients suitable for immunotherapy, referring to these immune indicators is expected to make the treatment more precise and effective (Na et al., 2024). Now, researchers are striving to optimize these indicators and also plan to combine them with other molecular characteristics and clinical symptoms, so that patients can be classified more accurately and the most appropriate treatment plans can be found. 4.3 Treatment monitoring is conducted using liquid biopsy Liquid biopsy, especially the analysis of circulating tumor DNA (ctDNA), provides a non-surgical method for monitoring the treatment response and disease progression of ovarian cancer (Singh et al., 2019). By examining the genetic and epigenetic changes in ctDNA, doctors can track the tumor condition in real time, possibly discover the causes of drug resistance and guide timely adjustment of treatment. This method can take samples multiple times. Compared with the traditional tissue examination, it can provide more comprehensive and updated tumor molecular information. Although the clinical application of ctDNa-based markers is still under development, technological advancements have made rapid and bedside diagnosis increasingly feasible. The use of liquid biopsy is expected to detect the recurrence of advanced ovarian cancer earlier, monitor minimal residual lesions, and formulate individualized treatment plans for continuous treatment (Singh et al., 2019). 5 Clinical Progress of Personalized Combined Treatment Regimens 5.1 PARP inhibitor trials PARP inhibitors have greatly improved the treatment of advanced ovarian cancer, especially for those patients carrying BRCA gene mutations or having defects in homologous recombination repair. Important clinical trials like SOLO and PRIMA have shown that compared with the use of placebos, continuous treatment with PARP inhibitors such as olaparib and niraparib can significantly prolong the time during which patients do not experience disease deterioration, whether they are newly diagnosed patients or those with disease recurrence (Secord et al., 2021; Konstantinopoulos and Matulonis, 2023). These studies have made PARP inhibitors key drugs for personalized treatment, and they are most effective in patients screened out through genetic testing. Recently, there have been studies attempting to use PARP inhibitors in combination with anti-angiogenic drugs (such as bevacizumab), hoping to achieve better therapeutic effects. From the perspective of the actual treatment effective rate and the time for patients' condition to stabilize, this combined treatment plan has achieved good results, especially in those newly diagnosed female patients with advanced ovarian cancer who have detected defects in homologous recombination repair (An et al., 2021; Secord et al., 2021). These research results indicate that selecting appropriate patients based on biomarkers and adopting combined treatment methods are very helpful for improving the treatment effect of patients. 5.2 Key immunotherapy research Immunotherapy, especially immune checkpoint inhibitors targeting PD-1/PD-L1, has been evaluated in the treatment of advanced ovarian cancer through important studies such as the KEYNOTE and CheckMate series. Although the treatment effective rate of using PD-1/PD-L1 inhibitors alone is generally average (only 8%~22.2%) in the unscreened population of ovarian cancer patients, the therapeutic effect will be better if these drugs are combined with other therapies (such as chemotherapy, anti-angiogenic therapy or PARP inhibitors) (Figure 2) (Palaia et al., 2020; An et al., 2021; Zhang et al., 2022). The ongoing and recently completed clinical trials mainly aim to break the suppression of the immune system by tumors and transform those "cold" tumors that respond poorly to immunotherapy into "hot" tumors that are vulnerable to attack by the immune system (Palaia et al., 2020; Zhang et al., 2022). Researchers are actively exploring various combined treatment regimens, aiming to enhance the activity of immune cells and improve the clinical therapeutic effect. Early research results show that some specific patient groups can obtain significant therapeutic benefits after adopting these combined treatment methods (An et al., 2021; Zhang et al., 2022). 5.3 Real-world evidence and meta-analysis results Through the summary and analysis of multiple studies and the research based on the actual clinical treatment
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 55 situation, it has been confirmed that the personalized combined treatment plan has an important value in the treatment of advanced ovarian cancer. For instance, a comprehensive study and analysis of the bevacizumab treatment regimen found that for both patients undergoing the first treatment and those with relapsed disease, the time to stable disease was significantly prolonged after using this regimen, and it had good safety. The probability of serious side effects such as intestinal perforation was also relatively low (Liu et al., 2021). These research results support the addition of targeted therapeutic drugs to the standard chemotherapy regimens for specific patients. Figure 2 Tumor microenvironment related immunotherapeutic strategies in ovarian cancer (Adopted from Zhang et al., 2022) Image caption: The graph shows multiple therapies combined with PD-1/PD-L1 blockades to boost the immune response, including chemotherapy, antiangiogenic therapy, PARP inhibitor, adoptive cell therapy, vaccine-based therapy, oncolytic therapy and T cell immunomodulators (Adopted from Zhang et al., 2022) Data from actual clinical treatment also indicate that personalized treatment strategies are crucial. Combining chemotherapy with targeted treatment methods such as PARP inhibitors and anti-angiogenic drugs can lead to better therapeutic effects (Franco et al., 2024). More and more clinical studies and translational studies are constantly providing a basis for the best treatment plan, emphasizing that early detection of the disease, selection of appropriate patients based on biomarkers, and adoption of combined treatment plans are crucial for improving the therapeutic effect of advanced ovarian cancer (Cortez et al., 2017; Franco et al., 2024). 6 The Combination of Individualized Treatments and Multiple Treatment Methods 6.1 Use it together with chemotherapy or arrange the sequence properly Individualized treatments, such as targeted drugs and immunotherapy, are increasingly being used in combination with conventional chemotherapy or with a well-arranged medication sequence to enhance the therapeutic effect of advanced ovarian cancer. For example, molecular targeted drugs selected based on the tumor genetic characteristics of patients, when used in combination with platinum-based chemotherapy, can help deal with drug resistance problems and lead to better outcomes for patients (Bookman, 2016; Huang et al., 2023). Gene expression analysis can identify patients who may be resistant to first-line platinum-based chemotherapy, so that other targeted drugs can be used earlier before and after chemotherapy (Dressman et al., 2007). The planning method of the medication sequence is continuously being improved. After the completion of the initial chemotherapy, subsequent maintenance treatment with PARP inhibitors or anti-angiogenic drugs can prolong the duration during which the patient's condition is stable and does not deteriorate (Kuroki and Guntupalli, 2020). As for which specific drug to choose and when to start the medication, it needs to be determined based on the patient's genetic characteristics and molecular markers, so as to ensure that the treatment plan received by the patient can not only exert the maximum therapeutic effect according to the characteristics of their own tumor, but also minimize side effects to the greatest extent (Huang et al., 2023).
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 56 6.2 Methods of coordination between surgery and radiotherapy Surgical resection of the tumor remains the foundation of the treatment for advanced ovarian cancer, and combining it with individualized treatment is the key to optimizing the outcome. The amount of residual tumor after surgery is highly related to the effect of subsequent chemotherapy and the overall survival time, which makes the selection of appropriate patients and surgical plans an important part of individualized treatment (Nick et al., 2015). Preoperative assessment tools and methods are being developed to identify patients who can benefit the most from complete tumor resection and further individualize surgical care (Nick et al., 2015). Although radiotherapy is not commonly used in the treatment of ovarian cancer, researchers are exploring new combination strategies to combine it with targeted drugs and immunotherapy in the hope of exerting potential synergistic effects. Meanwhile, various rehabilitation programs including exercise, nutritional support and psychological counseling are also under research, aiming to reduce postoperative complications and promote the recovery of patients. This indicates the importance of incorporating supportive care measures into individualized treatment plans (Diaz-Feijoo et al., 2022). 6.3 The role of multidisciplinary teams (MDT) in the treatment plan Integrating personalized treatment into multiple treatment methods is a very complex process, which also reflects the importance of multidisciplinary teams (MDTs) in the treatment of ovarian cancer. The multidisciplinary team is composed of various experts such as gynecological oncologists, internal medicine oncologists, pathologists, and radiologists. They jointly analyzed the results of genetic testing, evaluated the feasibility of the surgery, and formulated personalized treatment plans suitable for the patients, pursuing both good therapeutic effects and taking into account the quality of life of the patients (Bookman, 2016; Kuroki and Guntupalli, 2020). This way of teamwork can ensure that both the patient's condition and personal circumstances are taken into comprehensive consideration when planning the treatment plan. Multidisciplinary teams also contribute to the faster application of new therapies, encourage patients to participate in clinical trials, and enable patients to benefit from the latest achievements of personalized medicine in a timely manner (Bookman, 2016). By coordinating the treatment work of different departments and formulating strategies in combination with the latest scientific research results, multidisciplinary teams are indispensable for providing comprehensive and patient-demand-centered treatment management for patients with advanced ovarian cancer (Kuroki and Guntupalli, 2020). 7 Evaluation of Safety and Health Economics 7.1 Management of adverse events in individualized treatment Compared with traditional chemotherapy methods, individualized treatment for advanced ovarian cancer, such as the use of PARP inhibitors and anti-VEGF monoclonal antibodies, is generally safer. However, some specific adverse reactions may still occur and need to be dealt with carefully (Guan and Lu, 2018; Guy et al., 2022). The use of PARP inhibitors often leads to blood-related problems, such as anemia, leukopenia, thrombocytopenia, and symptoms of gastrointestinal discomfort. However, anti-VEGF drugs may cause elevated blood pressure, proteinuria, and increase the risk of thrombosis. Early detection of these adverse reactions and timely intervention measures are crucial for patients to adhere to treatment and achieve better therapeutic effects. Judging from the safety data obtained from clinical trials and comprehensive studies, although most adverse reactions can be controlled, the standards for recording and classifying these reactions vary among different studies, which highlights the importance of unified monitoring standards. Formulating specialized response plans based on the conditions of each patient, including adjusting the dosage of medication and providing supportive care, is very necessary to reduce the side effects of drugs and enable patients to continuously benefit from the treatment (Guan and Lu, 2018; Guy et al., 2022). 7.2 Cost-effectiveness and current situation of insurance coverage The wide application of individualized treatment has brought about difficulties in terms of cost-effectiveness and medical insurance reimbursement. Although targeted drugs and immunotherapy can prolong the stabilization time
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 57 of patients' conditions and may even increase the overall survival time of patients, the treatment cost is too high, imposing an economic burden on both the medical system and patients. Cost-benefit analysis shows that these treatment methods have the best effect in the patient population screened by biomarkers, which also explains the importance of precisely selecting patients to maximize the therapeutic value (Cortez et al., 2017). Under different regions and insurance policies, the medical insurance reimbursement for individualized treatment varies greatly. Generally, it depends on whether the clinical evidence is sufficient and whether the relevant biomarker tests or treatment indications have been approved. With an increasing amount of data on the long-term efficacy and safety of individualized treatment, medical insurance payers and policymakers pay more attention to the actual treatment effect and the results of health economics analysis to formulate reimbursement policies to ensure that patients can receive treatment fairly and conveniently (Cortez et al., 2017). 7.3 Quality of life (QoL) and health economics research Quality of life (QoL) assessment is the core consideration of individualized treatment, as its goal is not only to prolong survival, but also to maintain or improve the well-being of patients (Cortez et al., 2017). Studies suggest that compared with traditional chemotherapy, targeted therapy and immunotherapy may bring about a better quality of life, especially when adverse reactions are effectively managed and the treatment meets individual needs (Guan and Lu, 2018). Patient-reported outcomes are increasingly being incorporated into clinical trials to comprehensively assess the impact of treatment on daily functions and symptom burden (Guy et al., 2022). Research in the field of ovarian cancer health economics is continuously advancing, and there is an increasing emphasis on integrating the data of patients' quality of life and the real situation in actual treatment into the cost-benefit analysis model. These research and analysis results can help rationally allocate medical resources, provide guidance for clinical treatment, and also contribute to promoting personalized treatment plans that are both helpful for patients' treatment and have medical value (Cortez et al., 2017; Guy et al., 2022). 8 Difficulties and Future Directions 8.1 Standardization issues of sample acquisition and testing Obtaining high-quality tumor samples for molecular and biomarker testing remains a major challenge in individualized treatment of advanced ovarian cancer. The differences in tumors, the scarcity of available tissues, and the trauma of biopsies may all affect the conduct of comprehensive genetic and immune analyses, which are important for guiding targeted drugs and immunotherapy (Morand et al., 2021). In addition, the lack of a unified method for sample collection, processing and analysis may lead to unstable test results and complicate the interpretation of biomarker data and its clinical application (Li and Li, 2024; Tavares et al., 2024). It is crucial to unify the testing methods. Only in this way can the test results obtained from different laboratories and hospitals be stable and reliable. If there is no universally recognized biomarker detection standard, such as the detection standard for homologous recombination deficiency (HRD) score or PD-L1 expression level, it is easy to have inconsistent standards when selecting patients, affecting the therapeutic effect (Morand et al., 2021; Tavares et al., 2024). To solve these problems, it is necessary for all parties to cooperate and formulate unified operation norms and quality control methods for molecular detection of ovarian cancer. 8.2 The potential of multi-omics and AI-assisted decision-making Integrating multiple analytical techniques such as genomics, transcriptomics, proteomics and metabolomics is conducive to a deeper understanding of the tumor characteristics of ovarian cancer and exploring therapeutic breakthroughs (Tavares et al., 2024). By integrating molecular information at different levels, doctors can more accurately distinguish patient types, predict treatment responses, and identify new therapeutic targets, laying the foundation for the development of more precise and efficient individualized treatments (Morand et al., 2021). Currently, artificial intelligence (AI) and machine learning technologies are increasingly applied in analyzing complex multi-omics data to assist in clinical decision-making. These tools can identify patterns and predictors that are not easily detectable by conventional methods, thereby improving the accuracy of patient stratification
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 58 and optimizing treatment strategies (Morand et al., 2021; Tavares et al., 2024). With the continuous advancement of technology, AI is expected to play a key role in promoting the development of individualized medicine and addressing the current treatment challenges of ovarian cancer. 8.3 Obstacles and solutions for global promotion Although individualized treatment has made progress, there are still significant obstacles to its wide application, especially in areas with insufficient resources. High costs, difficulty in accessing advanced diagnostic technologies and different medical conditions in various regions may limit the use of molecular tests and targeted drugs by many patients worldwide. In addition, the economic burden brought by new therapies in some areas and the lack of insurance coverage make these problems more difficult to solve (Cortez et al., 2017; Chandra et al., 2019). To solve these problems, it is crucial for the international community to join hands and cooperate, share technologies, and develop affordable and easy-to-operate diagnostic platforms. Unifying the standards of clinical treatment, attracting more people to participate in clinical trials, and increasing investment in the training of medical staff can also promote the development of personalized treatment for ovarian cancer worldwide (Cortez et al., 2017; Chandra et al., 2019). Only by ensuring that everyone can equally access innovative treatment methods can the treatment effect of ovarian cancer be improved and the gap in medical levels among different regions be reduced. 9 Concluding Remarks Personalized treatment has greatly revolutionized the treatment model for advanced ovarian cancer, enabling doctors to tailor treatment plans based on each patient's genetic characteristics and actual condition. The continuous advancement of targeted therapies such as PARP inhibitors and anti-angiogenic drugs, as well as immunotherapy methods, has brought hope for extending the time during which patients' conditions do not deteriorate. Some patients with ovarian cancer are even expected to achieve long-term stable control of their conditions. Compared with the uniform standard treatment methods in the past, nowadays, by analyzing the genetic characteristics of tumors and combining biomarkers to plan treatment strategies, doctors can more accurately screen suitable patients, ensuring treatment effects while minimizing drug side effects to the greatest extent. Current clinical treatment recommendations particularly emphasize the importance of multidisciplinary collaboration. Tumor reductive surgery, platinum-based chemotherapy, and targeted therapy or immunotherapy tailored to the individual patient's condition are usually combined. When choosing a specific treatment method, it is necessary to base it on reliable biomarker and genetic testing results. This can not only improve the treatment effect but also avoid unnecessary side effects. However, there are still some key issues that need to be urgently addressed at present, such as how to arrange the sequence and combination of treatments, how to deal with the problem of drug resistance, and how to unify the standards of molecular testing, so as to ensure that all patients can receive personalized treatment fairly. Future research should focus on improving multi-omics techniques, leveraging artificial intelligence to make treatment plans more tailored to the specific circumstances of each patient, and accurately assess the post-treatment outcomes. In addition, it is necessary for all parties to make joint efforts to unify the detection standards of biomarkers, so that more patients can access advanced diagnostic technologies, and at the same time eliminate the differences in the implementation of personalized treatment around the world. The ongoing clinical trials and translational research are crucial for identifying new therapeutic targets, optimizing combined treatment plans, and paying attention to patients' treatment experiences. This is conducive to improving the survival rate and quality of life of patients with advanced ovarian cancer. Acknowledgments I extend my sincere thanks to Dr. Zhou for their feedback on the initial draft of this study .
Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 50-61 http://medscipublisher.com/index.php/cge 59 Conflict of Interest Disclosure The author affirms that this research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. 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