Fig. 4: Schematic overview of therapeutic application and mechanism of AAV gene therapy targeting ovarian cancer.

A This schematic illustrates a conceptual framework for incorporating AAV-based gene therapy into the current standard treatment regimen for ovarian cancer. Following maximal cytoreductive surgery and adjuvant chemotherapy with paclitaxel and carboplatin, AAV gene therapy—targeting angiogenesis or immune modulation pathways—is administered either in parallel with or sequentially after chemotherapy. The addition of gene therapy aims to enhance the durability of treatment response and significantly extend the duration of PFS beyond what is typically achieved with chemotherapy alone. This strategy addresses the critical need for therapeutic interventions that can delay relapse and improve long-term outcomes in ovarian cancer patients. B This illustration depicts the proposed molecular mechanism of AAV-mediated gene therapy targeting ovarian cancer. AAV vectors can be administered either intravenously (IV) or intraperitoneally (IP). Although the evaluation of administration routes lies beyond the scope of this review, it remains a critical consideration due to the anatomical characteristics of ovarian cancer, which predominantly resides within the peritoneal cavity. Determining the more effective route for AAV delivery—IV or IP—may significantly influence therapeutic efficacy. Engineered AAV capsids capable of efficiently infecting residual, microscopic ovarian cancer cells following maximal cytoreductive surgery can facilitate the delivery and expression of therapeutic genes within both ovarian tumor cells and cancer stem cells. Ideally, the anti-cancer proteins encoded by these genes should exert not only cell-autonomous anti-tumor effects in transduced cells, but also paracrine effects on neighboring malignant cells, thereby enhancing the overall therapeutic response.