The landscape of ovarian cancer is shifting from a single-biomarker paradigm to a more comprehensive, multi-biomarker approach. Presentations at the Society of Gynecologic Oncology (SGO) 2026 Annual Meeting on Women’s Cancer highlighted advances in biomarker testing, precision treatment strategies, and ongoing barriers to equitable access to clinical trials.

Following these presentations, featured expert Melissa A. Geller, MD, MS, FACOG, was interviewed by Conference Reporter Medical Director Lauren Weinand, MD. Clinical perspectives from Dr Geller on these findings are presented here.

In ovarian cancer, I think we are transitioning from a model that only looks at the BRCA/homologous recombination deficiency (HRD) paradigm to a multi-biomarker model. Currently, we have multiple clinically actionable biomarkers that go beyond BRCA and HRD, including FRα expression, microsatellite instability-high or tumor mutational burden-high, and HER2- expression.

At the recent SGO 2026 Annual Meeting on Women’s Cancer, a poster presented by Joseph Kim, MD, caught my eye (poster 1582). It looked at the impact of a national continuing medical education (CME) program in parallel with a multicenter quality improvement (QI) initiative on germline and HRD testing in the context of recent PARP inhibitor label changes in ovarian cancer. The online CME program gave educational updates on the importance of germline and HRD testing and aided in patient selection for PARP inhibitors. With the combination of CME classes and the QI initiative, investigators were able to ensure that cancer treatment teams conducted appropriate biomarker testing and selected the correct patients for PARP inhibitor therapy in individuals with advanced ovarian cancer, in line with recent label revisions.

This study demonstrates how a QI initiative that integrates guideline-concordant treatment with precision medicine was able to achieve an 11.8% increase (from 88.2% to 100%) in germline BRCA or HRD testing rates and a 10.2% increase (from 77.8% to 88%) in HRD testing rates (when BRCA test results were negative). This was achieved by incorporating standardized biomarker testing workflows in individuals with advanced ovarian cancer. This presentation really shows the value of such a model in providing guideline-concordant care.

Another relevant presentation at this year’s SGO meeting, which was presented by Ann Liu from Johns Hopkins University, looked at policy and system gaps in biomarker-driven gynecologic cancer trials across the United States (abstract 132). This was a cross-sectional analysis that looked at the distribution of gynecologic cancer therapeutic clinical trials relative to the burden of each cancer using state-level incidence data published by the National Cancer Institute (NCI).

In this analysis, 1119 unique trials were identified, of which 490 (43.8%) required biomarker testing for enrollment. Heat maps revealed substantial misalignment—many of the states with the highest gynecologic cancer incidences had very few biomarker trials. Although states with insurance mandates for biomarker testing generally had more trials, states with fewer mandates for insurance coverage also had significantly more biomarker-requiring trials. In other words, states may have biomarker-driven trials available but may not have the insurance mandates to cover the biomarker testing. This illustrates significant system- and policy-based barriers to enrollment of representative populations in clinical trials. Overall, we need better policies to decrease barriers to enrollment in clinical trials, which we know is a major issue across the country.

Finally, at the SGO 2026 Annual Meeting on Women’s Cancer, Emese Zsiros, MD, PhD, from Roswell Park Comprehensive Cancer Center, presented an open-label, single-arm, phase 2 trial looking at olaparib in combination with dual ICI therapy (ie, durvalumab and tremelimumab) in recurrent epithelial ovarian cancer in patients with a BRCA mutation or HRD (poster 1105). Importantly, we know that ICIs alone yield very minimal activity in recurrent ovarian cancer, with durable benefit reported in less than 10% of patients. We also know that PARP inhibitors enhance tumor immunogenicity by promoting the accumulation of DNA fragments, which triggers the production of type I interferons, thus providing a rationale for combining a PARP inhibitor with an ICI (eg, PD-L1 and CTLA-4 blockade).

This study enrolled 40 patients with enrichment for platinum-resistant disease (n = 25) compared with those with platinum-sensitive disease (n = 15). Among evaluable patients, the objective response rate was modest (9%), although the clinical benefit rate was higher (64%). Not surprisingly, both the median duration of response and the median progression-free survival were longer for platinum-sensitive patients vs platinum-resistant patients (median duration of response: 9.5 months vs 5.6 months, respectively; median progression-free survival: 5.2 months vs 2.8 months, respectively). This triplet combination was well tolerated, and more than half of patients achieved clinical benefit. The takeaway from this study is that platinum response (sensitive vs resistant) and BRCA status were important in determining outcomes regardless of PD-L1 expression, which really drives home the importance of considering biomarkers and treatment history when combining a PARP inhibitor with an immune-based therapy.