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. 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 a 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
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
| 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) |
Treatments for BRCA or HRD-positive* Patients
| *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” |
| Drug(s) |
Clinical Notes |
| Olaparib (Lynparza) |
PARP inhibitors (Lynparza and Rubraca) may be just as effective as standard chemo in BRCA-positive* patients who have recurred more than once
To see how effective these drugs are, click here, and scroll down.
To see side effects for these drugs, click here.
To see prescribing information, click here for olaparib or click here for rucaparib.
|
| Rucaparib (Rubraca) |
| Niraparib (Zejula) |
PARP inhibitor Zejula may be an effective alternative to standard chemo in BRCA or HRD-positive* patients who have had at least 3 prior chemotherapy regimens
To see how effective these drugs are, click here, and scroll down.
To see side effects for these drugs, click here.
To see prescribing information, click here. |
Promising Drugs in Clinical Trials
| *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”. |
| Drug(s) |
Trial Phase |
Clinical Notes |
Olaparib (Lynparza)
Cediranib |
III (results pending)
|
For patients that are not BRCA-positive*, adding Cediranib to Lynparza 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. |
Niraparib (Zejula)
Bevacizumab (Avastin)
|
II
|
For patients that are not BRCA* or HRD**-positive, 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. |
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.
Standard of Care Treatments
| 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 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. |
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).
To see how effective this drug is, click here. |
Treatment for BRCA-positive* Patients
| *BRCA-positive patients have a mutation in the BRCA1 or BRCA2 gene detected in their blood (germline mutation) or tumor (somatic mutation) |
| Drug(s) |
Clinical Notes |
| Olaparib (Lynparza) |
PARP inhibitors (Lynparza and Rubraca) 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, and scroll down.
To see side effects for these drugs, click here.
To see prescribing information, click here for olaparib or click here for rucaparib. |
| Rucaparib (Rubraca) |
| Niraparib (Zejula) |
PARP inhibitor (Zejula) may be an effective alternative to standard chemo in BRCA-positive* patients who have had at least 3 prior chemotherapy regimens
To see how effective these drugs are, click here, and scroll down.
To see side effects for these drugs, click here.
To see prescribing information, click here. |
Promising Drugs in Clinical Trials
| *BRCA-positive patients have a mutation in the BRCA1 or BRCA2 gene detected in their blood (germline mutation) or tumor (somatic mutation) |
| Drug(s) |
Trial Phase |
Clinical Notes |
Mirvetuximab Soravtansine
|
III |
Folate receptor-targeted cytotoxic drug may be more effective than standard chemo
To see detailed Phase III results, click here.
For ongoing trials with this drug, click here. |
Niraparib (Zejula)
Pembrolizumab (Keytruda) |
II
|
Patients that are not BRCA-positive* may benefit from PARP inhibitors (Zejula) if immunotherapy (Keytruda) is added
To see detailed Phase II 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 being evaluated in clinical trials for treatment of platinum-resistant recurrent ovarian cancer. Visit the clinical trials page and scroll down to see them.
