{
  "abstract": "Poly (ADP-ribose) polymerase inhibitors (PARPi) have revolutionized the management of high-grade serous ovarian cancer (HGSOC). Yet, current treatment decisions remain almost exclusively guided by static BRCA/homologous recombination deficiency (HRD) genotyping. This paradigm is increasingly challenged by a profound eligibility–benefit gap: real-world data show 93.4% of patients are PARPi-eligible, but only 22.0% achieve meaningful 2-year progression-free survival benefit, compounded by 10–30% HRD test failure rates, inability to capture dynamic resistance evolution, and negligible predictive value in the ~50% of HGSOC that are homologous recombination-proficient. This narrative review, based on literature up to June 2026, systematically evaluates functional biomarkers that complement BRCA/HRD testing by assessing real-time tumor biology. To our knowledge, this is the first review to integrate these biomarkers into a unified whole-disease-course framework accounting for evidence level, assay cost, and global resource setting. RAD51 immunohistochemistry directly visualizes homologous recombination repair capacity, achieving 95% accuracy in predicting PARPi response in preclinical patient-derived xenograft models and demonstrating robust predictive value in prospective clinical cohorts. The KELIM model, derived from early CA-125 kinetics and evaluated in >12,000 patients within prospective trial and registry datasets, provides a no-additional-assay-cost, tissue-independent readout of chemosensitivity with potential for broad, low-cost global deployment. Circulating tumor DNA enables noninvasive longitudinal monitoring of resistance, potentially preceding radiographic progression by weeks to months. Exploratory immune and artificial intelligence-based multimodal markers further refine response stratification. We propose deployment of these biomarkers at four critical clinical nodes—diagnosis, post-chemotherapy, maintenance, and progression—to guide therapy selection dynamically. By transitioning from static genotype-based eligibility to real-time functional phenotyping, this integrated strategy aims to close the eligibility–benefit gap and advance adaptive precision oncology for ovarian cancer globally. As a narrative review, this work aims to offer forward-looking conceptual frameworks and stimulate future research rather than to establish high-level clinical evidence or formal guidelines.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Gynecologic Cancer, Shaanxi Provincial Cancer Hospital, Xi’an",
    "Department of Pathology, Shaanxi Provincial Cancer Hospital, Xi’an"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tao Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Pengchuang Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Ruxing Xi"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaowei Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lijuan Hu"
    },
    {
      "affs": [
        0
      ],
      "name": "Yahui Shen"
    },
    {
      "affs": [
        0
      ],
      "name": "Kai Tao"
    },
    {
      "affs": [
        1
      ],
      "name": "Jianrong Lu"
    },
    {
      "affs": [
        0
      ],
      "name": "Guoqing Wang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/58wdrky8cvg2k.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1989686",
  "fulltext_url": "https://europepmc.org/articles/PMC13711281",
  "id": "58wdrky8cvg2k",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1989686/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2730|PARP inhibition in cancer therapy"
    ]
  ],
  "openalex": "W7221590255",
  "pdf_url": "https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1989686/pdf",
  "pmcid": "PMC13711281",
  "pmid": "42948144",
  "published": "2026-10-13",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/58wdrky8cvg2k.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:13Z",
      "native_id": "10.3389/fonc.2026.1989686",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1989686/full"
    },
    {
      "first_seen": "2026-10-31T00:20:34Z",
      "native_id": "MED:42948144",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42948144"
    },
    {
      "first_seen": "2026-10-31T12:22:05Z",
      "native_id": "PMC13711281",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fonc.2026.1989686"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|PARP inhibition in cancer therapy",
      "subfield": "oncology"
    }
  ],
  "title": "Functional biomarkers complementing static BRCA/HRD testing for dynamic PARP inhibitor therapy in ovarian cancer: a narrative review",
  "title_text": "Functional biomarkers complementing static BRCA/HRD testing for dynamic PARP inhibitor therapy in ovarian cancer: a narrative review",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:05Z",
  "url": "https://research.draconitic.com/paper/58wdrky8cvg2k",
  "venue": "Frontiers in Oncology",
  "versions": []
}