Systemic Therapy for Non-Serous Ovarian Carcinoma

Yanin Chávarri-Guerra; Eduardo González-Ochoa; Héctor De-la-Mora-Molina; Enrique Soto-Perez-de-Celis


Chin Clin Oncol. 2020;9(4):52 

In This Article

Abstract and Introduction


Ovarian cancer is one of the top ten most common cancers in women around the world, with high-grade serous epithelial cancer being the most frequent type. However, around a quarter of cases consist of non-serous epithelial ovarian cancer (EOC), which is a heterogeneous group of malignancies that includes endometroid, mucinous, clear cell carcinoma (CCC), and carcinosarcoma. Another relevant group of non-epithelial tumors are those arising from germ cells or sex-cord stromal cells, which account for about 10% of all ovarian cancers. Although there are similarities in the presentation, evaluation, and management of these tumors, they have unique characteristics in terms of epidemiology, tumor biology, tumor marker expression, and response to treatment, warranting a different approach to each one of them. Collectively, the treatment of most of EOC include surgical cytoreduction followed by adjuvant systemic platinum-based chemotherapy. The most common chemotherapy and route of administration for systemic treatment is paclitaxel plus carboplatin given intravenously. However, the treatment of EOC has been rapidly evolving and emerging targeted therapies such as poly (adenosine diphosphate-ribose) polymerase inhibitors, immune checkpoint inhibitors, and antiangiogenic agents are also available. On the other hand, non-EOC responds well to combination chemotherapy used to treat testicular cancer (bleomycin, etoposide, cisplatin) and has a good prognosis. Frontline chemotherapeutic regimen selection differs according to histological subtype, molecular alterations, and patient characteristics. Here, we review specific characteristics of non-serous and non-EOC emphasizing the peculiarities of systemic therapy for each subtype.


Ovarian cancer is the eight most common cancer in women around the world. In 2018 alone, 295,000 women were diagnosed with ovarian cancer and 184,000 died as a consequence of the disease.[1] Ovarian cancer is a heterogeneous disease which can be classified in epithelial and non-epithelial origin. Among epithelial ovarian cancer (EOC), high-grade serous carcinoma is the most common, comprising around 70% of all cases. Other less common epithelial tumors include endometroid, mucinous, clear cell carcinomas (CCC), and carcinosarcomas. Among those with non-epithelial origin, germ cell tumors and sex cord-stromal tumors are most frequent[2] (Figure 1) These subtypes differ in their clinical presentation, genomics, biomarkers, response to chemotherapy, and prognosis (Table 1).

Figure 1.

Epithelial ovarian cancer frequency by histology (3).

Management of these types of tumors might be challenging due to their rarity and the scarce information on the efficacy of treatment. The main purpose of this review is to summarize the published literature on the systemic management of patients with non-serous EOC.