Platinum-resistant ovarian cancer, treated through a needle.

Standard care. Surgery and platinum–taxane chemotherapy, with bevacizumab in selected cases, then PARP-inhibitor maintenance for BRCA-mutated or HRD-positive disease. Platinum-sensitive recurrence is treated with another platinum doublet, then a PARP inhibitor. Platinum-resistant disease is treated with single agents in sequence (pegylated liposomal doxorubicin, weekly paclitaxel, topotecan) and with mirvetuximab for folate-receptor-alpha-positive tumors. Intravenous (IV) checkpoint blockade has been largely ineffective in ovarian cancer, and there is no established immune option once PARP inhibition and the antibody–drug conjugate have failed.

Ablation alone gives local control of one deposit. Heat-based ablation risks injuring the bowel, bladder and ureters next to pelvic and abdominal deposits.

This approach. Non-thermal pulsed electric field (PEF) ablation (cryoablation where appropriate) of one measurable deposit, with immunotherapy injected into the same site in the same session. It is offered under physician review for platinum-resistant or post-PARP progression. The rationale is that ovarian cancer is immunologically "cold", that BRCA-mutated and HRD-positive tumors carry more neoantigens than wild-type tumors, and that breaking the tumor open exposes those antigens while the injected agents are intended to stimulate the immune response. In our clinical observations, treating one deposit produces a response at untreated sites in the abdomen or elsewhere.

The procedure, step by step

1. Case review. CT of the abdomen and pelvis, PET, and the biomarker reports (BRCA, HRD score, MSI, folate receptor alpha, p53), read by the Williams Cancer Institute team.
2. Protocol design. The intratumoral combination is tuned to BRCA/HRD status, the immune profile and the prior lines of treatment.
3. Guidance and ablation. Image-guided percutaneous access to a measurable pelvic, peritoneal or nodal site. PEF where bowel, bladder or ureter is adjacent; cryoablation where appropriate.
4. Intratumoral injection. Through the same access, into the ablation bed, in the same session.
5. Setting and time. About an hour for the procedure under conscious sedation, and about two hours of recovery. Most procedures are outpatient under conscious sedation; general anesthesia or an overnight stay is rarely required.
6. Follow-up. CA-125 and imaging at 6–8 weeks. Repeat procedures as indicated; the number of treatments is decided with the patient's physician, in coordination with the patient's gynecologic and medical oncology teams.

Agents. The injected immunotherapy is a multi-agent combination. The agents and doses are set per patient by the treating physician.

The immune conversion cycle, in clinical terms. Ablation disrupts the tumor and exposes its full antigen repertoire, not a pre-selected subset. The injected immunotherapy then remodels the tumor microenvironment, priming, recruiting and activating immune cells and releasing the brakes on them. Immune-mediated lysis exposes further antigens, which re-prime the response (epitope spreading), producing a broader, polyclonal, systemic response with memory, converting a cold tumor hot. This is WCI’s stated rationale, in Dr. Goodyear’s framing, borne out in our clinical observations.

Evidence. Intratumoral delivery concentrates drug in the injected tumor: in mice with colorectal tumors and no ablation, anti-CTLA-4 injected into a tumor reached about 14 times the day-7 level of IV dosing in that tumor, while untreated tumors received no more than with IV and half the dose reached the blood within an hour [1]. That is mouse data in a different cancer; it does not test ablation and does not show a distant-site effect. No published WCI ovarian series exists. The procedure described on this page is intratumoral. WCI's own gynecologic source also describes intraperitoneal (into the abdominal cavity) immunotherapy in recurrent ovarian, endometrial and cervical cancer. No ovarian cancer case with scans and a written record is on file yet; the patient accounts on this page are patients' own words, not medical records. Sources

1. Meyblum L, et al. J Immunother Cancer 2023. PMID 37949616. DOI 10.1136/jitc-2023-007433.
2. Shree T, et al. Clin Cancer Res 2025. PMID 39745391.

• Frontline — Standard care: surgery, platinum–taxane chemotherapy with or without bevacizumab, then PARP maintenance for BRCA/HRD-positive disease. This approach is rarely used here.
• Recurrent, platinum-sensitive — Standard care: a platinum doublet, then a PARP inhibitor. Considered in selected cases alongside standard care, to add an immune response.
• Recurrent, platinum-resistant — Standard care: single-agent sequences (pegylated liposomal doxorubicin, weekly paclitaxel, topotecan, mirvetuximab). Ablation of a reachable deposit with intratumoral immunotherapy, aiming to re-engage an immune response the peritoneal environment suppresses.
• After PARP and mirvetuximab — Available lines narrow. Multi-agent intratumoral treatment is considered as a next option, case by case.

WCI's stated candidacy criteria: platinum-resistant or platinum-refractory disease · progression on a PARP inhibitor (BRCA/HRD-positive) · progression on mirvetuximab (folate-receptor-alpha-positive) · oligoprogressive disease on systemic therapy · BRCA-mutated disease, on the rationale that it carries more neoantigens.

WCI's stated exclusions: bowel obstruction without a management plan · massive ascites limiting procedural feasibility · active severe infection · uncorrectable bleeding disorder · very poor performance status (ECOG 3 or worse). The online candidacy check also excludes ascites without a measurable target. Each case is individually evaluated by the Williams Cancer Institute team.

Records to send: CT of the abdomen and pelvis · PET · biomarker reports (BRCA, HRD score, MSI, folate receptor alpha, p53) · recent CA-125 · a list of treatments so far, with dates. The physician confirms the list per case.

Setting. Procedure about an hour, recovery about two. Most procedures are outpatient under conscious sedation; general anesthesia or an overnight stay is rarely required.

Follow-up. CA-125 and a scan at 6–8 weeks; the number of treatments is decided with the patient's physician; the patient's gynecologic oncologist is kept informed throughout.