The FDA has authorized pembrolizumab combined with paclitaxel, optionally with bevacizumab, for treating recurrent ovarian cancers expressing PD-L1 protein. This represents the first immunotherapy-chemotherapy combination specifically approved for PD-L1 positive ovarian malignancies in the recurrent setting. The approval builds on growing evidence that immune checkpoint inhibitors can meaningfully extend survival in select ovarian cancer populations, a disease historically resistant to immunotherapy approaches. Unlike breast or lung cancers where PD-L1 expression has become routine biomarker testing, ovarian cancer immunotherapy has lagged due to lower response rates and the tumor's immunosuppressive microenvironment. This targeted approval for PD-L1 positive cases suggests a precision approach may finally unlock immunotherapy's potential in ovarian malignancy. However, only about 30-40% of ovarian cancers express meaningful PD-L1 levels, limiting the eligible population. The combination's effectiveness likely depends on pembrolizumab's ability to restore immune recognition while paclitaxel provides direct cytotoxic activity and potentially enhances antigen presentation. This approval could establish a new treatment paradigm for biomarker-selected ovarian cancer patients, though long-term survival data and optimal patient selection criteria remain critical questions.