Given the potential anti-neoplastic effects on some of the prostaglandins such as the cyclopentenone prostaglandins as well as the association of PGD2 with good prognosis in high grade serous ovarian cancer (Alves et al., 2019) as well as the positive effects of blocking PGE2 EP4 in modulating the tumor microenvironment (Hennequart et al., 2017), additional mechanistic studies exploring modulation of COX signaling downstream of the COX enzymes as a monotherapy and in combination with additional therapeutic interventions is warranted. This evidence concerns the gene PTGER4 and ovarian serous adenocarcinoma.