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Reactive oxygen species promote tumorigenic programs and platinum-based chemotherapy resistance in high-grade serous ovarian cancerReactive Oxygen Species May Drive Ovarian Cancer Progression

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Key Takeaway
Note that ROS are associated with promoting tumor progression and platinum-based chemotherapy resistance in ovarian cancer.

This narrative review synthesizes 19 in vitro studies to describe how reactive oxygen species (ROS) reinforce the tumorigenic program in high-grade serous ovarian cancer. The authors conclude that ROS are associated with carcinogenesis priming, where environmental toxicants increase ROS levels alongside inflammatory responses and DNA damage markers.

Mechanistically, the review argues that hypoxia, hormones, growth factors, and lipid signaling activate survival pathways such as HIF-1α/VEGF, JAK/STAT3, and AKT/mTOR through ROS-mediated mechanisms. Furthermore, ROS are associated with enhanced metastatic potential by influencing epithelial-to-mesenchymal transition markers, extracellular matrix remodeling, and matrix metalloproteinase regulation.

Regarding treatment resistance, the review suggests that ROS contribute to platinum-based chemotherapy resistance via altered mitochondrial dynamics and DNA damage response activation. While these findings suggest that mitochondria-targeted antioxidants may provide translational insights for ovarian cancer treatment, the evidence is of low certainty due to the narrative nature of the review and the use of in vitro models.

This review looked at 19 laboratory studies involving ovarian epithelial cells. These are the types of cells found in high-grade serous ovarian cancer. The researchers focused on how reactive oxygen species (ROS), which are molecules often created by environmental factors or cell stress, influence the behavior of these cancer cells.

The findings suggest that ROS may play several roles in cancer progression. They were linked to increased DNA damage and inflammation. Additionally, the study suggests that ROS might help cancer cells survive under low oxygen conditions, grow faster, and become more invasive. These processes can make it easier for tumors to spread and adapt to their environment.

One important finding is that ROS may contribute to resistance against platinum-based chemotherapy. This happens through changes in how cells manage energy and respond to damage. Because these results come from laboratory studies on cell cultures rather than human patients, the evidence is currently limited. These findings are early and do not yet provide a clear path for clinical treatment.

What this means for you:
Laboratory studies suggest that ROS may help ovarian cancer cells grow and resist chemotherapy treatments.

Common questions

What role do reactive oxygen species play in ovarian cancer?

In laboratory studies, reactive oxygen species (ROS) were linked to several factors that help cancer progress. These include increased DNA damage, inflammation, and the ability of cells to grow even when oxygen is low. They may also help cancer cells change their structure to move more easily into other tissues.

Can these molecules make chemotherapy less effective?

The review suggests that ROS might contribute to resistance against platinum-based chemotherapy. This happens through changes in mitochondrial dynamics and the way cells respond to DNA damage. However, this finding is based on laboratory cell studies rather than clinical trials in humans.

Is this research enough to change current treatments?

No, these findings are not yet ready to change how doctors treat patients. The study was a narrative review of 19 in vitro (laboratory) studies on cell cultures. Because it did not involve human subjects, the results are considered to have low certainty for immediate medical use.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
Ovarian cancer is often diagnosed at an advanced stage because its early symptoms are nonspecific, and the prognosis remains poor due to frequent recurrence and the development of drug resistance even after standard treatment. This review includes 19 in vitro studies and seeks to mechanistically summarize how reactive oxygen species (ROS) reinforce the tumorigenic program from the early stages of ovarian carcinogenesis to tumor progression, metastasis, and treatment resistance. Collectively, the selected studies suggest that exposure to environmental toxicants can increase ROS levels in ovarian epithelial cells, accompanied by inflammatory responses and elevated DNA damage markers, thereby creating a carcinogenesis-priming environment. During the progression stage, hypoxia, hormones, growth factors, and lipid signaling repeatedly activate survival and growth pathways, such as those involving HIF-1α/VEGF, JAK/STAT3, and AKT/mTOR, through ROS-mediated mechanisms to promote tumor cell proliferation, anti-apoptotic activity, and angiogenesis. In addition, ROS are associated with alterations in epithelial-to-mesenchymal transition-related markers, remodeling of the extracellular matrix, and regulation of matrix metalloproteinases, which enhance the metastatic and invasive potential of tumor cells. In the therapeutic context, ROS have been suggested to contribute to platinum-based chemotherapy resistance through mechanisms including changes in mitochondrial dynamics, activation of the DNA damage response, and reprogramming of ROS-dependent phosphorylation networks. Understanding the diverse molecular mechanisms and clinical manifestations associated with ROS expression in high-grade serous ovarian cancer (HGSOC) will contribute to a more precise understanding of its pathophysiology. Furthermore, studies on redox-targeted therapeutic strategies, particularly the application of mitochondria-targeted antioxidants, may provide valuable translational insights for the treatment of ovarian cancer and other ROS-related diseases.
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