What biomarkers should be tested for ovarian cancer?

Standard biomarker testing for ovarian cancer typically includes BRCA1 / BRCA2 (germline and somatic), HRD (Homologous Recombination Deficiency). Additional biomarkers may be tested depending on stage and clinical context.

When should ovarian cancer biomarker testing happen?

Biomarker testing should happen at diagnosis — before systemic therapy decisions. Many targeted therapies are only appropriate for specific biomarker profiles, so results are needed to choose the right first-line treatment.

Is germline genetic testing different from tumor biomarker testing?

Yes. Tumor (somatic) testing looks at the cancer itself to guide treatment. Germline testing, usually done on blood or saliva, looks at inherited mutations that may raise cancer risk for you and your blood relatives. Both can be important depending on the cancer type.

Biomarkers

Ovarian Cancer biomarkers — what to test

Ovarian cancer is one of the clearest cases for universal biomarker and germline testing at diagnosis. BRCA status and HRD status together drive most treatment and maintenance decisions, and have major implications for patients' family members.

Standard biomarkers

These are typically tested on every new diagnosis, or required before systemic therapy decisions, under current U.S. clinical guidelines.

BRCA1 / BRCA2 (germline and somatic)

Standard

What it is: Both inherited (germline — tested by blood) and tumor (somatic — tested on the tumor) mutations count.

Why test: Open eligibility for PARP inhibitors in first-line and maintenance settings. Germline mutations have family implications. ~15-20% of epithelial ovarian cancers have a BRCA mutation (germline or somatic).

Therapies it unlocks:

Olaparib (Lynparza) — first-line maintenance
Niraparib (Zejula)
Rucaparib (Rubraca)

HRD (Homologous Recombination Deficiency)

Standard

What it is: A broader genomic scar pattern indicating DNA-repair pathway dysfunction, detectable even in BRCA-wild-type tumors.

Why test: HRD-positive BRCA-wild-type tumors still benefit from PARP inhibitor maintenance, especially combined with bevacizumab.

Therapies it unlocks:

Olaparib + bevacizumab for HRD+ first-line maintenance
Niraparib monotherapy (regardless of HRD status in some settings)

Context-specific biomarkers

Tested depending on cancer stage, subtype, family history, or as part of broader NGS (next-generation sequencing) panels.

Folate Receptor Alpha (FRα)

What it is: FRα expression on tumor cells.

Why test: Opens eligibility for mirvetuximab soravtansine, an FRα-targeted antibody-drug conjugate.

Therapies it unlocks:

Mirvetuximab soravtansine (Elahere) — for FRα-high platinum-resistant disease

MSI / MMR

What it is: Less common in ovarian than colorectal but occasionally MSI-H.

Why test: Opens eligibility for immunotherapy when present.

Therapies it unlocks:

Pembrolizumab (tumor-agnostic for MSI-H)

Questions to ask your oncologist

What biomarker testing are you doing on my tumor?
Are there any tests we are skipping that I should consider?
Will we wait for results before starting systemic therapy, or start something interim?
Is germline genetic testing appropriate for me, given my personal and family history?
If a biomarker test is indeterminate, what is the plan?

Next steps

FDA-approved ovarian cancer drugs →

See which FDA-approved drugs match each biomarker profile above.

Ovarian Cancer clinical trials →

Active recruiting trials, many biomarker-matched.

Biomarkers explained: full guide →

Deeper background on how biomarker testing works.

Germline genetic testing →

Different from tumor testing; addresses inherited cancer risk and family implications.

Genetic testing cost →

What germline and tumor molecular tests cost, and how insurance covers each.

BRCA test cost →

What patients pay in practice for BRCA1/2 testing and ACA preventive coverage rules.