Few solid tumors have undergone as profound a therapeutic transformation as epithelial ovarian cancer. Once managed through a relatively linear sequence of surgery followed by chemotherapy, contemporary ovarian cancer care has evolved into a multidisciplinary, molecularly informed strategy in which surgical expertise, biomarker testing, and maintenance therapy collectively determine long-term outcomes. The updated Algerian National Therapeutic Guidelines in Medical Oncology reflect this evolution by embracing a more personalized approach to treatment, aligning national practice with the rapidly advancing landscape of gynecologic oncology.
Modern Management Begins with Accurate Staging and Molecular Profiling
The management of ovarian cancer begins long before the first incision. Establishing the extent of disease and accurately characterizing tumor biology are now essential steps that guide every subsequent therapeutic decision.
The 2026 Algerian guidelines recommend contrast-enhanced CT of the chest, abdomen, and pelvis as the reference imaging modality, while pelvic MRI and PET imaging are reserved for selected clinical situations. Biological evaluation extends beyond CA125 to include hormonal and germ-cell markers when clinically indicated. Most importantly, molecular assessment—including both germline and somatic BRCA1/2 testing together with evaluation of homologous recombination deficiency (HRD)—has become an integral component of routine management rather than a specialized investigation performed later in the disease course.
This evolution reflects one of the most important changes in ovarian cancer care. Molecular profiling is no longer performed simply to characterize the tumor; it directly determines which patients are most likely to benefit from targeted maintenance strategies following first-line treatment. As access to molecular diagnostics expands, precision medicine is progressively becoming part of routine oncology practice in Algeria.
Diagnostic laparoscopy also plays a central role in treatment planning. By assessing disease burden using validated scoring systems—including the Fagotti score during staging laparoscopy or the Peritoneal Cancer Index (PCI/Sugarbaker) during laparotomy—surgeons can better determine whether complete upfront cytoreduction is realistically achievable.
Surgery Remains the Cornerstone, but the Goal Is Complete Cytoreduction
Despite remarkable advances in systemic therapy, surgery remains a cornerstone of ovarian cancer management. However, contemporary surgical management focuses not simply on tumor removal but on achieving complete macroscopic cytoreduction, a principle consistently associated with improved survival.
For patients with early-stage disease (FIGO I–II), comprehensive surgical staging—including bilateral salpingo-oophorectomy, total hysterectomy, and complete peritoneal staging—remains the standard of care. Adjuvant platinum-taxane chemotherapy is recommended for most patients, while fertility-preserving surgery may be considered in carefully selected young women with low-risk early-stage tumors.
Management of advanced disease (FIGO III–IV) has become increasingly individualized. The updated guidelines clearly emphasize that incomplete cytoreductive surgery should not be performed. Whenever complete resection (R0) appears achievable, primary debulking surgery remains the preferred strategy. When optimal cytoreduction is unlikely, neoadjuvant platinum-based chemotherapy followed by interval debulking surgery offers a more appropriate therapeutic pathway.
Rather than applying a single surgical algorithm, treatment decisions are increasingly guided by multidisciplinary tumor board discussion, integrating surgical expertise, imaging findings, disease distribution, and patient fitness into a personalized treatment strategy.
Maintenance Therapy Has Entered the Molecular Era
Perhaps the most important therapeutic evolution reflected in the updated guidelines lies in the expanding role of maintenance therapy.
For patients with advanced epithelial ovarian cancer, bevacizumab may be incorporated into first-line platinum-based chemotherapy and continued as maintenance treatment, particularly for stage IIIB–IV disease or when residual disease remains after surgery.
Even more transformative is the incorporation of PARP inhibitors into routine clinical practice. Maintenance therapy has become genuinely biomarker-driven, allowing treatment to be individualized according to each patient’s molecular profile rather than relying on a uniform post-chemotherapy strategy.
Patients with BRCA-mutated tumors may receive olaparib, while those with BRCA-mutated and/or HRD-positive disease who have already received bevacizumab may benefit from the combination of olaparib and bevacizumab. Niraparib further expands maintenance options and may be considered regardless of BRCA or HRD status in appropriately selected patients.
This transition from standardized maintenance toward biologically guided treatment represents one of the clearest examples of precision oncology becoming embedded in routine clinical practice.
Recurrent Ovarian Cancer Requires Individualized Treatment Selection
Although therapeutic options have expanded considerably, the management of recurrent ovarian cancer continues to rely on careful clinical stratification.
The platinum-free interval remains the principal determinant of treatment selection, while previous exposure to PARP inhibitors or anti-angiogenic therapy, tumor histology, disease burden, and patient performance status all contribute to individualized decision-making.
Patients experiencing platinum-resistant relapse are generally treated with sequential non-platinum chemotherapy, with or without bevacizumab. Conversely, platinum-sensitive recurrence allows reintroduction of platinum-based combinations, consideration of secondary cytoreductive surgery in appropriately selected patients, and maintenance therapy for eligible patients who have not previously received PARP inhibition.
Rather than following a rigid algorithm, recurrent ovarian cancer management increasingly reflects a personalized therapeutic strategy built around disease biology and prior treatment history.
A New Therapeutic Philosophy
The updated Algerian National Therapeutic Guidelines illustrate that ovarian cancer management has evolved far beyond the traditional sequence of surgery followed by chemotherapy. Contemporary care now integrates expert cytoreductive surgery, multidisciplinary evaluation, molecular diagnostics, targeted maintenance therapy, and individualized treatment planning into a continuous therapeutic pathway.
This transformation is not defined simply by the introduction of new drugs, but by a broader change in clinical philosophy. Treatment decisions increasingly depend on selecting the right intervention for the right patient at the right time, using molecular biology and multidisciplinary expertise to personalize care throughout the entire disease journey.
Clinical Perspective
The greatest evolution in ovarian cancer care is not the availability of new therapies alone, but the transition toward precision-guided management. The updated Algerian recommendations demonstrate how surgery, molecular diagnostics, biomarker-driven maintenance therapy, and multidisciplinary decision-making are becoming inseparable components of modern practice. As access to high-quality molecular testing continues to expand, personalized ovarian cancer care is progressively becoming a reality across Algeria, bringing national practice ever closer to contemporary international standards.
Clinical Pearls
Comprehensive molecular profiling, including BRCA1/2 and HRD assessment, has become an essential component of first-line therapeutic planning rather than a secondary investigation.
Complete cytoreductive surgery remains the single most important surgical objective, while multidisciplinary evaluation determines whether primary or interval debulking offers the greatest benefit.
The most significant therapeutic evolution lies not in individual drugs themselves, but in the emergence of biomarker-guided maintenance strategies that personalize treatment beyond first-line chemotherapy.
