Miriana Hijaz

Ovarian Cancer: Advancing Care Through Innovation and Precision Medicine

Ovarian cancer remains a major challenge in women’s health, often detected late and requiring complex care. Yet, advances in molecular profiling, targeted therapies, and early detection tools are changing the outlook for patients worldwide. “Hospitals” Magazine spoke with Miriana Hijaz, MD, FACOG, FACS, Division Director of Gynecologic Oncology at Henry Ford Health, to discuss the latest breakthroughs, personalized treatment strategies, and the future of ovarian cancer management.

Setting the Scene

How has our understanding of ovarian cancer’s biology evolved in recent years, and what key discoveries are shaping new approaches to the disease?

Over the past several years, the field of oncology has witnessed remarkable advances, and ovarian cancer biology has been at the forefront of this progress. Where ovarian cancer was once regarded as a largely uniform diagnosis with limited therapeutic options, we now understand it as a heterogeneous disease with distinct molecular subtypes. Increasingly, treatment is guided not by a one-size-fits-all approach, but by the unique biological signature of each tumor. Advances in molecular profiling have identified actionable pathways that open the door to immunotherapies, anti-angiogenic agents, targeted agents and novel combination regimens. These insights have not only expanded the treatment armamentarium available to patients but have also allowed clinicians to tailor therapies in ways that maximize efficacy while minimizing unnecessary toxicities. In essence, ovarian cancer care is shifting from a generalized framework toward a personalized medicine paradigm.

The Ongoing Challenge of Early Detection

What are the most significant challenges that still prevent early diagnosis, despite advancements in imaging and biomarker research?

One of the greatest challenges in detecting ovarian cancer early is that the disease often develops silently, with vague or nonspecific symptoms that can be mistaken for common benign conditions. Despite progress in imaging and biomarker research, no screening tool has yet proven reliable enough for widespread use, largely because the disease is biologically diverse and early-stage tumors shed very few detectable signals. This combination of subtle symptoms, lack of highly sensitive and specific markers, and tumor heterogeneity continues to make early diagnosis difficult.

Are there any promising developments in screening protocols or diagnostic tools that could realistically shift detection toward earlier stages?

Yes, there are several promising avenues. We have recently seen the development of liquid biopsy technologies, which analyze tumor DNA or other cancer-related signals in the blood. These technologies hold great potential for earlier and less invasive detection. In parallel, researchers are refining multimodal approaches that combine biomarkers with advanced imaging and several risk-stratification algorithms, aiming to identify women at the highest risk more accurately. While these tools are not yet ready for routine screening, they represent important steps toward shifting ovarian cancer diagnosis to earlier, more treatable stages.

How might artificial intelligence and molecular profiling work together to improve early detection and treatment planning?

Molecular profiling now allows us to generate a detailed map of a tumor’s genetic and biological landscape, identifying the key mutations and pathways that drive disease. When paired with artificial intelligence, this information becomes even more powerful. AI algorithms can integrate molecular data with clinical and imaging findings, sometimes even helping to determine the origin of tumors that were previously difficult to differentiate.

Just as importantly, AI can assist in predicting which therapies are most likely to benefit specific patients, making treatment more precise and effective. This synergy between molecular profiling and AI is moving us closer to a truly personalized approach, one in which each woman’s ovarian cancer can be diagnosed earlier and treated according to the unique biology of her tumor.

Breakthroughs in Treatment

What breakthroughs in targeted therapy or immunotherapy have had the greatest impact on patient survival in the past five years?

In the past five years, ovarian cancer treatment has seen remarkable progress. PARP inhibitors, especially for patients with BRCA mutations or DNA repair deficiencies, have significantly extended progression-free survival. Targeted therapies like antibody-drug conjugates, have been developed to deliver chemotherapy directly to tumor cells, improving effectiveness while reducing side effects. On the immunotherapy side, we’re learning that certain genetic mutations, can predict better responses to those therapies and can sometimes be added to combination treatments to improve progression-free survival. Exciting experimental approaches, including ovarian cancer vaccines and adoptive cell therapies, are also emerging, pointing toward a future where treatments are increasingly personalized and more effective.

How has the use of PARP inhibitors evolved, and in which patient populations are they showing the most benefit today?

The role of PARP inhibitors in ovarian cancer has expanded significantly, offering substantial benefits to a broader range of patients. Initially, these therapies were primarily used in patients with BRCA1 or BRCA2 mutations. However, recent studies have demonstrated that PARP inhibitors also provide clinical benefits to patients with homologous recombination deficiency (HRD), regardless of BRCA status.

Currently, PARP inhibitors are most beneficial as a maintenance therapy following first-line chemotherapy for patients with newly diagnosed advanced ovarian cancer who have HRD-positive tumors, including those with BRCA mutations. These patients experience significant improvements in their progression-free survival. Additionally, patients with platinum-sensitive recurrent ovarian cancer, with BRCA mutations, also benefit from PARP inhibitors, achieving prolonged progression-free survival. Ongoing research is aiming to further refine patient selection and explore combination therapies to enhance the efficacy of PARP inhibitors in ovarian cancer treatment.

How is genetic testing for BRCA1/2 and other mutations shaping personalized treatment strategies for ovarian cancer?

Testing for BRCA and other mutations has now become a central component of ovarian cancer treatment. Not only does it help guide therapies, but it also plays a big role in stratifying patients for various targeted therapies and clinical trials. In addition, and beyond treatment, testing informs risk-reducing strategies for patients and their families, making it a cornerstone of truly personalized ovarian cancer management.

Can liquid biopsies or circulating tumor DNA analysis meaningfully change how we monitor treatment response and recurrence risk?

Although Liquid biopsies and circulating tumor DNA (ctDNA) analysis are not yet standard of care in ovarian cancer, but emerging studies show real promise. ctDNA can detect molecular signs of recurrence earlier than imaging or symptoms, offering a window for timely intervention. It is also being explored to guide the duration of therapies, helping tailor treatment length to individual disease dynamics and potentially improving both outcomes and quality of life.

Surgical Approaches and Care Strategies

Has the role of surgery in ovarian cancer management changed with the advent of more effective systemic therapies?

Despite advances in systemic therapies, surgery remains a cornerstone of ovarian cancer management. Research has shown that patients who are optimally cytoreduced, especially to no visible residual disease consistently achieve the best survival outcomes. Thus, while systemic treatments continue to evolve, maximal surgical effort remains critical to improving prognosis.

Life Beyond Treatment

With survival improving for some patients, how is the focus shifting toward long-term quality of life, fertility preservation, and psychosocial support?

Indeed, survival is improving for many women with ovarian cancer, and now the focus is increasingly shifting toward survivorship and long-term quality of life. Dedicated survivorship can offer multidisciplinary care that extends beyond cancer control. These teams often include reproductive endocrinologists for fertility preservation, psychologists and social workers for emotional and social support, and specialists in menopause and sexual health to manage treatment-related effects. This holistic approach ensures that care is not only life-prolonging but also life-enhancing.

Global & Future Perspectives

How do disparities in healthcare access impact ovarian cancer outcomes globally, and what strategies could bridge this gap?

Disparities in healthcare access profoundly affect ovarian cancer outcomes. Women in low-resource settings often face delayed diagnosis, limited access to surgery or high-volume surgical centers, and scarce availability of targeted therapies or clinical trials.

Bridging this gap requires expanding global access to services like genetic testing, affordable treatments, and surgical expertise, alongside strengthening healthcare infrastructure and training. International collaborations and equitable clinical trial enrollment are also key to ensuring advances in ovarian cancer care benefit women everywhere.

Which emerging technologies or research areas do you believe will define the next decade of ovarian cancer management?

I believe the future lies within more personalized and precision-based medicine, with technologies aiming at early detection, fighting therapy resistance, being able to monitor treatment outcomes in real-time, as well as AI-powered precision profiling that can match patients to the therapies most likely to work. We aim for knowledge and expertise that will ensure women don’t just live longer, but live better.