Newly Diagnosed

The Basics

The National Comprehensive Cancer Network (NCCN) recommends that ovarian Survival Benefit Not Enough to Justify Centralized Ovarian Cancer Carecancer patients should be initially treated with surgery and chemotherapy. Around 75 percent of women with advanced stage disease who receive this regimen go into remission.

Treatments are based on the cancer histology type, stage and each patient’s individual needs. Some women diagnosed with stage I cancer localized to a single ovary may opt to only have that ovary and fallopian tube removed. This is sometimes called fertility-sparing surgery.

In some women with advanced stage III or IV disease, a surgeon will recommend chemotherapy before surgery (called neoadjuvant therapy) to reduce the size of the tumors so they can be removed more easily during the debulking surgery.

The standard of care for most women is treatment that  includes a platinum drug, like carboplatin, a taxane, like paclitaxel (Taxol) and sometimes bevacizumab (Avastin).  More recently, a class of drugs called PARP (Poly ADP-ribose polymerase) inhibitors have been approved as maintenance treatment following this chemotherapy.  Such drugs can help keep the cancer from coming back.

For women diagnosed with low grade serous or endometrioid types, hormonal therapy — aromatase inhibitors like letrozole (Femara) or anti-estrogens like tamoxifen (Nolvadex) —  may be an option.

Treatments for Newly Diagnosed

This table lists the most commonly used treatments for women diagnosed with advanced ovarian cancer. Groups of drugs are used in combination and are taken either before (neo-adjuvant) or after surgery.  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.

There are other treatments, including PARP inhibitors and immunotherapies, being evaluated in clinical trials for initial treatment of ovarian cancer. Visit the clinical trials page and scroll down to find them.

 

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.

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.