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Caution: checkpoint inhibitors in first-line ovarian cancer
Immunotherapy added to first-line chemotherapy has failed to extend survival in ovarian cancer in every large trial so far; its only win is in PD-L1-positive platinum-resistant disease.
IMagyn050 (atezolizumab), JAVELIN Ovarian 100 (avelumab), and DUO-O (durvalumab ± olaparib) showed no OS benefit in newly diagnosed disease. KEYNOTE-B96 (pembrolizumab + weekly paclitaxel) is the exception, in PD-L1-positive platinum-resistant relapse. Ovarian cancer is immunologically 'cold' with low TMB.
Rationale
Low neoantigen burden, immunosuppressive ascites, and myeloid-rich microenvironment blunt T-cell responses; chemotherapy-induced priming appears necessary for benefit.
Evidence
Three negative first-line phase 3 trials; one positive relapsed-setting trial.