Unmet needs and emerging therapeutics in low-grade serous ovarian carcinoma: from chemoresistance to precision medicine.

Low-grade serous ovarian carcinoma (LGSOC) is a rare and clinically distinct subtype of ovarian cancer, which presents unique challenges in diagnosis and treatment. LGSOC is characterized by low proliferation rates, high expression of hormone receptors, and frequent alterations in the mitogen-activated protein kinase (MAPK) pathway. Initial standard treatment includes cytoreductive surgery followed by platinum-based chemotherapy and endocrine therapy. However, high recurrence rates (~80%) and poor responses to chemotherapy underscore the urgent need for new treatment strategies. Endocrine therapy is being investigated in the upfront setting, and recent advances in targeted therapies, including MAPK pathway inhibitors and investigational agents such as cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, are shaping the evolving LGSOC treatment landscape. Notably, the recent US Food and Drug Administration approval of the avutometinib/defactinib combination for KRAS-mutated recurrent LGSOC marks a significant milestone in targeted therapy for this disease. Despite these advances, challenges remain in optimizing sequencing strategies and overcoming acquired resistance. This review addresses the importance of understanding the distinct pathophysiology of LGSOC, diagnostic challenges, limitations of conventional treatments, and evolving therapeutic approaches in LGSOC.