The Basics
Most patients with advanced disease (diagnosed at stage III or IV) have no disease remaining after completing surgery and platinum-based chemotherapy. Unfortunately, despite initial response to treatment, 75 to 80 percent will eventually see their disease recur and some women will not have their cancer eliminated by the first-line treatments.
Recurrence happens because chemotherapy may not eliminate all of the cancer cells (they are too small to be visible on a scan). Those remaining cells are either resistant to the initial treatment or are not growing during treatment. Only growing cells can be killed by chemotherapy. 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 influences subsequent treatment.
If recurrence occurs more than six months after ending treatment, it is considered platinum-sensitive and re-treatment with a combination of platinum and another drug is often beneficial. If the recurrence occurs less than six months later, the disease is considered platinum-resistant and non-platinum drugs are prescribed to treat it. If the cancer continues to grow while the treatment, it is considered refractory.
New drugs in various stages of clinical development can sometimes be better options than standard chemotherapies. Some of these have clinical results available.
There are many approved and investigational drugs (agents in clinical trials) from which to choose. This is where understanding the genomic changes in a tumor can make an enormous difference. Some of these mutations can have a direct bearing on which treatments will be the most appropriate for a patient’s unique cancer. Information from a Tumor Blueprint can be helpful in making these decisions.
Treatments for Platinum-Sensitive Recurrence
These tables 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 standard treatment options.
Standard of Care for Platinum-Sensitive Recurrence
| 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 can increase the time before cancer comes back or gets worse.
To see how effective these drugs are, click here.
To see side effects for these drugs, click here. |
Carboplatin or Cisplatin
Gemcitabine (Gemzar)
Bevacizumab (Avastin) |
Carboplatin or Cisplatin
Paclitaxel (Taxol)
Bevacizumab (Avastin) |
Carboplatin or Cisplatin
Liposomal doxorubicin (Doxil) |
Treatments for BRCA-positive* Patients
| *BRCA-positive patients have a mutation in the BRCA1 or BRCA2 gene detected in a blood or tumor test |
| Drug(s) |
Clinical Notes |
| Olaparib (Lynparza) |
PARP inhibitors may be just as effective as standard chemo in BRCA-positive* patients who have recurred more than one time.
To see how effective these drugs are, click here.
To see side effects for these drugs, click here.
|
| Rucaparib (Rubraca) |
Promising Drugs in Clinical Development for Platinum-Sensitive Recurrence
| *BRCA-positive patients have a mutation in the BRCA1 or BRCA2 gene detected in a blood or tumor test |
| Drug(s) |
Trial Phase |
Clinical Notes |
Olaparib (Lynparza)
Cediranib |
III
|
For patients that are not BRCA-positive*, adding Cediranib to Lynparza may make the treatment as effective as standard chemo
To see detailed Phase II results, click here. |
Carboplatin
Paclitaxel (Taxol)
Farletuzumab |
II |
Adding this folate receptor-targeted antibody to chemo increased time until cancer comes back in women with low CA125
To see detailed Phase III results, click here.
To see the ongoing trial with this drug, 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
These tables 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 standard treatment options.
Standard of Care for Platinum-Resistant or Refractory Recurrence
| Drug(s) |
Clinical Notes |
Paclitaxel (Taxol)
Bevacizumab (Avastin) |
Standard of care is treatment with single agent Taxol, Doxil, Topotecan or Gemzar.
Adding Avastin can increase the time before the cancer comes back or gets worse.
To see clinical trial results for these drugs, click here.
To see side effects for these drugs, click here. |
Liposomal Doxorubicin (Doxil)
Bevacizumab (Avastin) |
Topotecan (Hycamtin)
Bevacizumab (Avastin) |
| Gemcitabine (Gemzar) |
| Bevacizumab (Avastin) |
Taking Avastin can decrease fluid build-up in the abdominal or peritoneal cavity (called ascites). |
Treatment for BRCA-positive* Patients
| *BRCA-positive patients have a mutation in the BRCA1 or BRCA2 gene detected in a blood or tumor test |
| Drug(s) |
Clinical Notes |
| Rucaparib (Rubraca) |
PARP inhibitors may be just as effective as standard chemo in BRCA-positive* patients.
To see how effective these drugs are, click here.
To see side effects for these drugs, click here. |
| Olaparib (Lynparza) |
Promising Drugs in Clinical Development for Platinum-Resistant Recurrence
| Drug(s) |
Trial Phase |
Clinical Notes |
| Mirvetuximab Soravtansine (IMGN853) |
III
|
Folate receptor-targeted antibody + cytotoxic drug conjugate (ADC) may be as effective as chemotherapy + Avastin
To see detailed Phase I results, click here.
For ongoing trials with this drug, click here. |
| Prexasertib |
II |
Chk1/2 inhibitor may be more effective than standard chemo
To see detailed Phase II results, click here.
For ongoing trials with this drug, 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-resistant recurrent ovarian cancer. Visit the clinical trials page and scroll down to see them.
can continue to divide and ultimately form new tumors, which can happen months or years after treatment.