Molecular Testing in Ovarian and Endometrial Cancer: Evolving Approaches and Best Practices

This OncLive Insights program focuses on optimizing outcomes in ovarian and endometrial cancer through the use of antibody-drug conjugates (ADCs). The discussion opens with an overview of the growing importance of ADCs in gynecologic oncology and sets the stage for a deeper dive into molecular testing as a foundation for personalized treatment. The speakers express enthusiasm for how ADCs, along with molecular profiling, are transforming therapeutic strategies and highlight the shift toward more targeted, mechanism-based care.

A key theme is the role of molecular testing at diagnosis. For ovarian cancer, comprehensive genetic screening for DNA damage response genes—especially BRCA1 and BRCA2—is emphasized as essential. These results guide the use of PARP inhibitors and support cascade testing in families. In endometrial cancer, mismatch repair (MMR) testing and microsatellite instability status are crucial to identify patients who may respond to immunotherapy. Additional markers such as HER2 and folate receptor expression, along with broader next-generation sequencing (NGS), are increasingly used to tailor treatment options and qualify patients for clinical trials.

The conversation also explores practical challenges in obtaining and using molecular data. Limited tissue availability from initial biopsies can hinder testing, especially in ovarian cancer where necrotic samples are common. There are also difficulties in rebiopsying patients safely, particularly when tumors are in inaccessible or risky locations. Tumor heterogeneity and evolving protein expression over time further complicate treatment planning, raising questions about when and how often to retest. Despite these hurdles, the speakers underscore the importance of adapting to these complexities and express hope that tools like such as liquid biopsy will eventually streamline and enhance molecular diagnostics in gynecologic oncology.