Little or No Disease After Treatment

The Basics

After therapy is completed, when there is no evidence of disease or sometimes when “Surviving it once, yes. Twice? I don’t know about that”: My Ovarian Cancer Came Backthere is still some disease left, patients may choose observation or maintenance. Observation is exactly what the name implies: there is no cancer treatment but patients are monitored to determine if the cancer has returned.

Maintenance is designed to prolong remission and lower the risk of cancer recurrence. It can also be used when there is still cancer present to prevent it from growing. Patients may take maintenance therapies for months or even years. PARP inhibitors are the newest drugs to be shown helpful in these situations.

 

Maintenance Treatments After First-line Chemotherapy

The tables below (click + to open) list the drugs most commonly used for maintenance after first-line treatment. These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as preferred treatment options.   Please take this information to your doctor as an aid for your discussions.

With the recent approval of olaparib (Lynparza) as maintenance therapy following first line treatment, testing of the blood for germline (hereditary) mutations in the BRCA1 and 2 genes is important – even if there is no family history.  If negative, tumor testing can be performed to determine if a BRCA mutation is found only in the tumor (called “somatic”). The Clearity Tumor Blueprint will check for the presence of a BRCA mutation as well as provide additional helpful information about the tumor’s molecular characteristics.

There are other treatments, including other PARP inhibitors and vaccines, being evaluated in clinical trials for maintenance treatment after first-line therapy. Visit the clinical trials page and scroll down to find them.

Maintenance Treatments After Recurrence

This table lists the drugs most commonly used when cancer returns more than 6 months after the last platinum treatment and then responds again to platinum-based chemotherapy. These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as preferred treatment options.    Treatment with these drugs generally starts about eight weeks after completing chemo. Please take this information to your doctor as an aid for your discussions.

Drug(s) Clinical Notes
*BRCA-positive patients have a mutation in the BRCA1 or BRCA2 gene detected in their blood (germline mutation) or tumor (somatic mutation).

**HRD stands for homologous recombination deficiency. This is similar to LOH, which stands for loss of heterozygosity. HRD and LOH are changes in tumor DNA that indicate the tumor looks like one that is BRCA-positive, also called “BRCAness”.

Olaparib (Lynparza) Approved for all patients with platinum-sensitive recurrence that responds again to platinum treatment. Women that are BRCA-positive* or have a positive HRD** test may benefit the most.

To see how effective these drugs are, click here.
To see side effects associated with this drug, click here.
To see prescribing information, click here for olaparib or click here for niraparib or click here for rucaparib.

Niraparib (Zejula)
Rucaparib (Rubraca)
Bevacizumab (Avastin) Adding Avastin to  chemo at recurrence — and continuing afterwards — helps keep the cancer from coming back
To see how effective this drug is, click here.
To see side effects associated with this drug, click here.
To see prescribing information, click here.

There are other treatments, including vaccines, being evaluated in clinical trials for maintenance after successful treatment for recurrence. Visit the clinical trials page and scroll down to find them.