Understanding Recurrent or Progressive Ovarian Cancer

The Basics

Most patients with advanced disease (diagnosed at stage III or IV) have no visible disease remaining after completing surgery and chemotherapy that includes platinum (usually carboplatin or cisplatin). Unfortunately, despite initial response to treatment, many will see their disease recur.

Recurrence happens because chemotherapy may not eliminate all of the cancer cells (they are too small to be visible on a scan). Those cancer cells can continue to divide and ultimately form new tumors, which can happen months or years after treatment.

Therapeutic choices after recurrence are complex. Many factors, such as how much time has passed since treatment with platinum and which drugs were given after that, come into play.

Platinum status is important since it predicts the likelihood that re-treatment with platinum will be effective and influences choice of subsequent treatment.

A platinum-sensitive recurrence occurs six months or more after ending treatment with platinum. Re-treatment with a combination of platinum and another drug is often beneficial.
A platinum-resistant recurrence occurs less than six months after the last platinum treatment. Non-platinum drugs are prescribed to treat it.
Platinum refractory cancer continues to grow while on treatment or recurs within a month after the last platinum treatment. Non-platinum drugs are prescribed to treat it.

In addition to standard chemotherapy, there are new drugs in various stages of clinical development that may also be effective. For some of these drugs, there are published reports describing their side effects and effectiveness.

Some clinical trials enroll patients whose tumors have specific biomarkers or gene changes. Therefore, having results from tumor biomarker testing (or a Tumor Profile analysis) is essential for identifying such treatment options.

Treatments for Platinum-Sensitive Recurrence

The tables below (click + to open) list the drugs most commonly used to treat cancer that has come back more than six months after the last platinum treatment. Groups of drugs are used in combination. These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as preferred treatment options. Your doctor will know about these and other options that are also available. Please take this information to your doctor as an aid for your discussions.

Standard of Care Treatments

To see how effective this drug is, click here , and scroll down.
To see side effects for this drug, click here.
To see prescribing information, click here.

Drug(s)	Clinical Notes
Carboplatin or Cisplatin	Standard of care is Carboplatin or Cisplatin combined with Gemzar, Doxil or Taxol. Adding Avastin to platinum-based chemo (and continuing as maintenance) can increase the time before cancer returns or gets worse. To see how effective these drugs are, click here. To see side effects for these drugs, click here. To see prescribing information, click here.
Carboplatin or Cisplatin Gemcitabine (Gemzar) Bevacizumab (Avastin)
Carboplatin or Cisplatin Paclitaxel (Taxol) Bevacizumab (Avastin)
Carboplatin or Cisplatin Liposomal doxorubicin (Doxil) Bevacizumab (Avastin)

Additional Options for Low Grade Serous Cancer Patients

Drug(s)	Clinical Notes
Trametinib (Mekinist)	MEK inhibitor (Mekinist) may be more effective than chemotherapy To see detailed Phase III results, click here. To see side effects associated with this drug, click here.

Promising* Drugs in Clinical Trials

For criteria used to designate these trial drugs as promising, click here.*
Drug(s)	Trial Phase	Clinical Notes
Niraparib (Zejula) Bevacizumab (Avastin)	II	Adding Avastin to Zejula may be an effective alternative to standard chemo To see detailed Phase II results, click here. For ongoing trials with these or similar drugs, click here.
Nivolumab (Opdivo) Bevacizumab (Avastin)	II	Combining the immune checkpoint inhibitor (Opdivo) with Avastin may be an effective non-chemo option for partially platinum-sensitive recurrence To see detailed Phase II results, click here. For ongoing trials with these or similar drugs, click here.

Promising* Drugs in Clinical Trials for Low Grade Serous Cancer Patients

For criteria used to designate these trial drugs as promising, click here.*
Drug(s)	Trial Phase	Clinical Notes
VS-6766 Defactinib	II	The RAF/MEK inhibitor VS-6766 alone, or in combination with defactinib, may be effective for patients with low grade serous ovarian cancer, including those who have been previously treated with a MEK inhibitor To see detailed Phase I results, click here. For ongoing trials with these or similar drugs, click here.

There are drugs in earlier stages of development that already have results. Visit the Trial Results page to see those.

There are other drugs, including PARP inhibitor combinations and immunotherapies, being evaluated in clinical trials for treatment of platinum-sensitive recurrent ovarian cancer. Visit the clinical trials page and scroll down to see them.

Treatments for Platinum-Resistant or Refractory Recurrence

The tables below (click + to open) list the drugs most commonly used for treating cancer has progressed on treatment (ie., refractory) or has come back less than 6 months after the last platinum treatment (ie., resistant). Groups of drugs are used in combination. These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as preferred treatment options. Your doctor will know about these and other options that are also available. Please take this information to your doctor as an aid for your discussions.