Platinum resistant ovarian cancer, usually defined as progression occurring within 6 months after completing platinum-based therapy, is a heterogeneous disease with poor prognosis and short survival (less than 18 months). It is typically considered as a “cold tumor”, characterized by reduced infiltration by immune cells, particularly CD8⁺ T cells. Response rate to anti-PD1/PD-L1 monotherapy is low, not exceeding 8%. Multiple therapeutic strategies are currently investigated in order to increase response rates to anti-PD1/PD-L1 through adding chemotherapy, anti-angiogenic agents, DNA damage (PARP inhibitors, cyclophosphamide and/or radiotherapy) or other immune checkpoint inhibitors (CTLA-4, etc.). Ovarian clear cell carcinoma, a rare histotype characterized by primary platinum-resistance, recently showed anecdotal but promising response rates to immune checkpoint blockade. Other immunotherapeutic approaches such as adoptive T cell therapy, vaccines and targeting myeloid immune checkpoints like “don’t eat me” signal CD47 are currently investigated. Each approach faces distinct challenges that will be reviewed here. Robust immunogenomics studies conducted in parallel of the ongoing trials will help into refining optimal immunotherapy combination for this lethal disease and identify predictive biomarkers.

铂类耐药卵巢癌，通常定义为完成铂类治疗后 6 个月内发生的进展，是一种预后不良且生存期短（小于 18 个月）的异质性疾病。它通常被认为是一种“冷肿瘤”，其特点是免疫细胞浸润减少，尤其是 CD8 ⁺T细胞。抗PD1/PD-L1单药治疗的反应率低，不超过8%。目前正在研究多种治疗策略，以通过添加化疗、抗血管生成剂、DNA 损伤（PARP 抑制剂、环磷酰胺和/或放疗）或其他免疫检查点抑制剂（CTLA-4）来提高对抗 PD1/PD-L1 的反应率， 等等。）。卵巢透明细胞癌是一种罕见的以原发性铂耐药为特征的组织型，最近显示出对免疫检查点阻断的传闻但有希望的反应率。目前正在研究其他免疫治疗方法，例如过继性 T 细胞疗法、疫苗和靶向髓系免疫检查点，如“不要吃我”信号 CD47。每种方法都面临着不同的挑战，本文将对此进行回顾。