Poly(ADP-ribose)聚合酶抑制剂（PARPi）已经给高级卵巢癌治疗领域带来了很大的进展。借助有针对性的维持疗法的出现，改善的生存率引发了对降低剂量策略的及时关注，目的是提高生活质量，同时不影响肿瘤学结果。全身治疗降低概念的出现将开创卵巢癌个体化治疗的新前沿。PARPi非常有效，以这些药物进行适当选择的患者可能需要较少的化疗来达到相同的肿瘤学结果。关键是将降低剂量限制在预后因素有利的狭窄亚种人群中，例如BRCA突变和（或）同源重组缺陷肿瘤的患者，在手术后或其他高风险临床因素后没有宏观残留疾病。潜在的降低剂量策略包括在新辅助设定中转移PARPi，初次去块术后缩减辅助化疗，减少PARPi的维持治疗时长，直接在间隔去块术后开始使用PARPi，省略维持治疗，以及在局部复发后继续使用PARPi（如果与局部治疗结合）。目前有数个正在进行的试验正在研究在卵巢癌中降低剂量策略的可行性和安全性，人们迫切期待其结果。本综述旨在讨论卵巢癌晚期全身治疗降低的当前趋势、局限性和未来展望。© IGCS and ESGO 2023. No commercial re-use. See rights and permissions. Published by BMJ.

Poly(ADP-ribose) polymerase inhibitors (PARPi) have sculpted the current landscape of advanced ovarian cancer treatment. With the advent of targeted maintenance therapies, improved survival rates have led to a timely interest in exploring de-intensified strategies with the goal of improving quality of life without compromising oncologic outcomes. The emerging concept of systemic treatment de-escalation would represent a new frontier in personalizing therapy in ovarian cancer. PARPi are so effective that properly selected patients treated with these agents might require less chemotherapy to achieve the same oncologic outcomes. The fundamental key is to limit de-escalation to a narrow subpopulation with favorable prognostic factors, such as patients with BRCA-mutated and/or homologous recombination-deficient tumors without macroscopic residual disease after surgery or other high-risk clinical factors. Potential de-escalation strategies include shifting PARPi in the neoadjuvant setting, de-escalating adjuvant chemotherapy after primary debulking surgery, reducing PARPi maintenance therapy duration, starting PARPi directly after interval debulking surgery, omitting maintenance therapy, and continuing PARPi beyond oligoprogression (if combined with locoregional treatment). Several ongoing trials are currently investigating the feasibility and safety of de-escalating approaches in ovarian cancer and the results are eagerly awaited. This review aims to discuss the current trends, drawbacks, and future perspectives regarding systemic treatment de-escalation in advanced ovarian cancer.© IGCS and ESGO 2023. No commercial re-use. See rights and permissions. Published by BMJ.