Current status and prospects of chemotherapy-free strategies in ovarian cancer.

This review provides a comprehensive overview of chemotherapy-free strategies in ovarian cancer (OC). We first outline the foundational biomarkers guiding targeted therapy, including homologous recombination deficiency for PARP inhibitors (PARPi), angiogenic pathways for anti-angiogenic agents, the tumor immune microenvironment for immunotherapies, hormone receptors for endocrine approaches, and emerging targets for antibody-drug conjugates. We then organize therapeutic strategies by clinical setting (frontline, platinum-sensitive recurrent, and platinum-resistant recurrent) to align with clinical decision-making. Current challenges are also addressed, including acquired resistance to PARPi and anti-angiogenic agents, the impact of prior PARPi exposure on platinum sensitivity, and practical concerns such as drug safety and cost. Finally, we present a critical view highlighting key unanswered questions and future challenges, emphasizing the need for biomarker-driven patient selection, resistance-overcoming combinations, and next-generation therapeutic platforms. This review aims to provide a practical framework for navigating the current landscape and future directions of chemotherapy-free approaches in OC.