Background/Objectives: Ovarian cancer is the most lethal gynaecological malignancy, mostly diagnosed at an advanced stage. Since PARP-inhibitor maintenance was introduced, BRCA1/2 and homologous recombination deficiency (HRD) status guide first-line therapy. We describe testing rates, treatment patterns and outcomes in a real-world cohort and compare patient characteristics by BRCA/HRD status.

Methods: Retrospective single-centre cohort of all patients with FIGO stage III–IV ovarian cancer diagnosed 2013–2024 at Klinikum Rechts der Isar, Technical University of Munich, Germany. Data were extracted from medical records and analysed in R (version 4.6.1). Progression-free (PFS) and overall survival (OS) were estimated by Kaplan-Meier; follow-up by reversse Kaplan-Meier. Group differences were tested using Wilcoxon, Kruskal-Wallis, χ² or Fisher’s exact tests.

Results: Of 756 screened patients, 431 were included (median age 65 years, range 22–89; FIGO III 82.8%, FIGO IV 17.2%; high-grade serous 88.9%). A BRCA1/2 mutation was documented in 52 patients (12.1%); HRD testing was performed in 74 (17.2%), of whom 43 (58.1%) were HRD-positive. HRD scores were significantly higher in patients without recurrence (p = 0.042). Complete macroscopic resection was achieved in 313 of 408 patients after primary debulking (76.7%). Neoadjuvant chemotherapy was given to 83 patients (19.3%), adjuvant chemotherapy to 335 (77.7%) and maintenance therapy to 187 (43.4%), most frequently bevacizumab (58.3%). At a median follow-up of 31 months, 228 patients (52.9%) had relapsed and 77 (17.9%) had died; median PFS was 29 months (95% CI 25–31). BRCA-mutated patients were significantly younger at diagnosis and less often presented with FIGO IV disease.

Conclusions: Despite high complete-resection rates, fewer than one in five patients underwent HRD testing, although higher HRD scores were associated with fewer recurrences. Systematic upfront BRCA/HRD testing should be standard in advanced ovarian cancer.

Elsa Haw just completed her medical studies at the Technical University of Munich (TUM), Germany. Her doctoral thesis at the Department of Obstetrics and Gynaecology, Klinikum Rechts der Isar, supervised by Prof. Bronger, examines real-world treatment and prognostic factors in advanced ovarian cancer. Alongside her studies, she holds a scientific staff position in the Department of Dermatology at TUM, researching cutaneous squamous cell carcinoma, and completed a research fellowship at Boston Children's Hospital, Harvard Medical School. Fluent in German, French and English, her clinical interests lie in surgical disciplines, including orthopedic and trauma surgery.