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

These tables 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.

PARP (Poly ADP-ribose polymerase) inhibitors, olaparib (Lynparza) and niraparib (Zejula) were recently approved as maintenance therapy following first line treatment based on their effectiveness in preventing recurrence.  Women with BRCA1 or 2 gene mutations detected in their blood (germline; hereditary) or tumor (somatic) received the most benefit from such treatment.  Therefore, genetic testing for inherited cancer risk can be 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.

One additional biomarker is called HRD (homologous recombination deficiency).  When this test is positive, it is likely that a PARP inhibitor could be very effective. HRD testing provides an estimate of the “BRCAness” characteristic of the tumor by measuring the genomic instability that results from problems with DNA damage repair. This increased damage occurs in tumors that do not have a functional BRCA protein (e.g., due to a mutated BRCA gene) and also occurs when the BRCA gene is fine and the BRCA protein is not made by the cancer cell or when other genes in this repair pathway are mutated. The tumor looks like BRCA is not working properly and the HRD test is positive. Studies show that women whose tumors are HRD positive may have more benefit from PARP inhibitor treatment than those whose tumors are HRD negative.

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.

PARP (Poly ADP-ribose polymerase) inhibitors, olaparib (Lynparza) and niraparib (Zejula) were recently approved as maintenance therapy following first line treatment based on their effectiveness in preventing recurrence.  Women with BRCA1 or 2 gene mutations detected in their blood (germline; hereditary) or tumor (somatic) received the most benefit from such treatment.  Therefore, genetic testing for inherited cancer risk can be 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.

One additional biomarker is called HRD (homologous recombination deficiency).  When this test is positive, it is likely that a PARP inhibitor could be very effective. HRD testing provides an estimate of the “BRCAness” characteristic of the tumor by measuring the genomic instability that results from problems with DNA damage repair. This increased damage occurs in tumors that do not have a functional BRCA protein (e.g., due to a mutated BRCA gene) and also occurs when the BRCA gene is fine and the BRCA protein is not made by the cancer cell or when other genes in this repair pathway are mutated. The tumor looks like BRCA is not working properly and the HRD test is positive. Studies show that women whose tumors are HRD positive may have more benefit from PARP inhibitor treatment than those whose tumors are HRD negative.

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.