Medical Oncologist
Ovarian cancer targeted therapy
Targeted Therapy for Ovarian Cancer: — PARP Inhibitors and Beyond
Targeted therapy for ovarian cancer is not one treatment — it is a category of treatments matched to specific molecular findings in your tumour. Whether PARP inhibitors apply to you depends on testing that your oncologist should arrange at or shortly after diagnosis.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- BRCA testing comes first — Both your blood and tumour tissue are tested, and the result decides which targeted treatment, if any, applies to you.
- PARP inhibitors are the main option — They work specifically in tumours with BRCA mutations or a broader DNA-repair deficiency called HRD.
- Eligibility is molecular, not stage-based — Being ineligible means a different treatment fits your tumour better — it is not a comment on how advanced your cancer is.
- Most treatment is tablet-based — PARP inhibitors are oral tablets taken at home, with regular clinic visits for blood tests and monitoring.
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Targeted therapy for ovarian cancer mainly uses PARP inhibitors for patients with BRCA mutations or homologous recombination deficiency. Testing is done on your tumour tissue and a blood sample. NCCN and ASCO recommend BRCA and HRD testing for all patients with high-grade serous ovarian cancer before treatment decisions are made.
Which mutations are tested before targeted therapy for ovarian cancer?
BRCA1 and BRCA2 are the most important mutations to test. Testing is done on both a blood sample — to check for an inherited mutation — and on your tumour tissue, to check for a mutation that arose in the cancer itself. Either finding can change your treatment options.
Homologous recombination deficiency, or HRD, is a broader category your oncologist may also test for. Some patients who do not carry a BRCA mutation still have an HRD-positive tumour, and this also affects which targeted treatments may be appropriate.
Microsatellite instability is tested in some cases to assess whether immunotherapy may be added to your plan. NTRK fusions are rare in ovarian cancer but, when present, open a separate targeted treatment pathway.
NCCN and ASCO recommend germline BRCA testing for all patients newly diagnosed with ovarian cancer. Somatic tumour testing and HRD testing decisions are made based on your cancer type and what your oncologist needs to guide your treatment plan.
How does the process work, from testing to starting treatment?
Tissue and blood are collected
If you have already had a biopsy, the stored tissue is usually sufficient for tumour testing. A separate blood draw is taken to check for an inherited BRCA mutation. In most cases, no additional procedure is needed.
Biomarker testing takes place
The laboratory analyses your samples for BRCA1, BRCA2, HRD status and any other relevant markers your oncologist has requested. Ask your team when to expect results — the timeline depends on the laboratory and which tests are being run.
Your oncologist reviews the results with you
Results are interpreted in the context of your cancer type, stage and general fitness. Not all positive results lead to the same treatment — the full picture matters, and your oncologist will explain what the findings mean for you specifically.
A treatment plan is agreed
If targeted therapy is appropriate, your oncologist will explain which drug class applies, whether it is used alongside or after chemotherapy, and what the aim of treatment is.
Treatment starts and monitoring begins
PARP inhibitors are oral tablets taken at home. You will have regular blood tests to monitor blood counts and organ function. Response-assessment scans are arranged at intervals your team decides.
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Which targeted treatments are used in ovarian cancer, and who are they for?
PARP inhibitors are the best-established targeted treatment in ovarian cancer. They work by blocking a DNA repair pathway that cancer cells with BRCA mutations or HRD depend on to survive. Patients who are BRCA-positive or HRD-positive and whose cancer responded to platinum-based chemotherapy are the group most likely to be considered for this class, typically as maintenance therapy.
Anti-angiogenic agents, which reduce the blood supply that tumours depend on, are used in some patients regardless of BRCA status. Whether this applies to you depends on your cancer's stage, histology, and how it responded to initial chemotherapy.
For the rare patient whose tumour carries an NTRK fusion, TRK inhibitors can be considered. These are used across tumour types wherever the fusion is found — the starting point of the cancer does not limit eligibility for this pathway.
Not every patient with ovarian cancer is eligible for targeted therapy. Ineligibility is a clinical judgement about your tumour's molecular profile — not a measure of how severe your cancer is or how many options remain.
What should you expect once targeted treatment starts?
PARP inhibitors are oral tablets, which means most of your treatment happens at home. Your oncologist will tell you how often to take them and what to do if a dose is missed.
Fatigue and nausea are the side effects people notice most often in the early weeks. Tell your team early rather than waiting through weeks of discomfort — dose adjustments are common and usually help.
Blood tests are scheduled regularly, particularly to monitor blood counts. A drop in red blood cells is the most common reason a dose adjustment is needed. Your team is watching for this and will act before it becomes a serious problem.
Response is assessed with imaging at intervals your team decides. Your oncologist will explain what the aim of treatment is and what a meaningful response looks like before you start.
Terms you may hear during your consultation
- PARP inhibitor
- A class of targeted drugs that block a DNA repair enzyme called PARP. Cancer cells with faulty DNA repair — due to BRCA mutations or HRD — depend on this pathway to survive, so blocking it causes them to die.
- BRCA mutation
- A change in the BRCA1 or BRCA2 gene that disrupts the cell's ability to repair DNA correctly. It can be inherited from a parent (germline) or acquired within the tumour itself (somatic). Both types can affect treatment decisions.
- Homologous recombination deficiency (HRD)
- A state in which the cancer cell cannot repair DNA breaks using its usual high-fidelity pathway. BRCA mutations are one cause of HRD, but other mechanisms can produce the same defect. A positive HRD result can qualify a patient for PARP inhibitor treatment even without a BRCA mutation.
- Germline mutation
- A genetic change present in every cell in your body, inherited from a parent. A germline BRCA mutation may have been passed on and has implications for your biological relatives, who may wish to consider genetic counselling.
- Somatic mutation
- A genetic change that arose in the tumour itself and is not present in your blood cells. It was not inherited and does not carry the same implications for family members as a germline mutation.
- Maintenance therapy
- Treatment given after an initial response to chemotherapy, intended to keep the cancer from returning or to slow its return. PARP inhibitors in ovarian cancer are most often used in this role.
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Common questions
Frequently asked questions
Is the BRCA test for ovarian cancer the same as for breast cancer?
Yes — BRCA1 and BRCA2 are the same genes, and the same inherited mutation can increase the risk of both ovarian and breast cancer. If you have already had BRCA testing for another reason, share those results with your oncologist. The difference is in what the result means for treatment: in ovarian cancer, a BRCA mutation or HRD-positive finding opens the door to PARP inhibitor therapy as part of your ovarian cancer treatment plan.
Do I need a new biopsy if I already had one?
Usually not. Biomarker testing is most often done on the tissue already taken during your original biopsy, and a separate blood draw covers the inherited mutation check. A repeat biopsy is occasionally needed if the original sample is too small, too degraded, or if the cancer has changed significantly since the first sample was taken. Your oncologist will tell you if this applies to you.
What if my BRCA result comes back negative?
A negative BRCA result does not rule out targeted therapy. Your oncologist may still test for HRD, which can qualify a patient for PARP inhibitors even without a BRCA mutation. If both results are negative, other treatments — including chemotherapy, anti-angiogenic agents, or combinations — remain options. A negative result narrows the list; it does not close it.
Can targeted therapy replace chemotherapy in ovarian cancer?
For most patients, no — targeted therapy is used alongside or after chemotherapy, not instead of it. PARP inhibitors are most commonly given as maintenance therapy, meaning they start after chemotherapy has achieved a response, with the aim of keeping that response for longer. Your oncologist will explain the sequencing that applies to your specific plan.
How long will I need to take a PARP inhibitor?
The duration depends on the treatment plan agreed with your oncologist. PARP inhibitors in maintenance therapy are generally taken for a defined period or until the disease changes — whichever comes first. Your oncologist will tell you what the planned duration is, what will be monitored, and under what circumstances the treatment may be adjusted or stopped. It is a reasonable question to ask before you start.
Should my daughters or sisters get tested if I have a BRCA mutation?
If your mutation is germline — found in your blood sample rather than only in your tumour — then yes, this has implications for your biological relatives. A germline BRCA mutation can be inherited, and your relatives may wish to discuss their own risk with a genetic counsellor. Your treating team can refer you to genetic counselling services, or your relatives can seek this independently. If your mutation is somatic only, the implications are different, and your oncologist can explain what applies in your situation.