Ovarian Cancer Recurrence: Need to Know
- Most women who undergo treatment for ovarian cancer will, unfortunately, experience a recurrence at some point.
- A regular blood test called CA-125 can monitor for recurrence.
- Maintenance therapy is used to try to prolong the remission time.
- A class of drugs called PARP inhibitors may be effective at delaying recurrence, especially in women with BRCA mutations.
Initial treatment for ovarian cancer usually involves a combination of surgery to remove as much of the cancer as possible, and chemotherapy. Although these treatments are very effective, most women who undergo them will, unfortunately, eventually experience a recurrence.
“Once we initiate ovarian cancer therapies, patients often wonder, how am I going to do with these treatments?” Dr. Kris Zanotti, a gynecologic oncologist at University Hospitals in Cleveland, tells SurvivorNet. “And I often tell them we get many, many clues along the way.”
How well a woman’s body responds to treatment — and how long the cancer stays in remission — will depend on several factors, Dr. Zanotti says. Some of the clues that can indicate how well a woman is responding to treatment are:
- How well debulking surgery went — were all visible signs of cancer removed?
- How patients respond to chemotherapy, as measured by a CA-125 blood test
- How low CA-125 levels have dropped by the end of chemo treatments
Some women do experience cures from ovarian cancer treatment, but a large majority of patients will experience a recurrence. For that reason, women should discuss maintenance therapy with their doctors
“When a cancer recurs, we may have different goals in mind,” Dr. Zanotti says. “The management of treatment-related toxicities [and] quality of life become even more important than at the initial setting.”
Holding Off Recurrence
In an attempt to prolong remission and postpone recurrences for as long as possible, some women will be given the option to go on maintenance therapy, Dr. Zanotti says.
The U.S. Food and Drug Administration (FDA) has approved the use of PARP inhibitors for women who have completed initial cancer therapies. These drugs, given orally, work by preventing cancer cells from repairing their damaged DNA, which causes them to die. “PARP inhibitors are anticipated to be highly effective in ovarian cancer patients that have BRCA1 or BRCA2 mutations, in either their blood lines or in their tumor, in preventing and delaying recurrence,” Dr. Zanotti says. And studies are showing that PARP inhibitors are also effective — though to a lesser extent — in women without those genetic mutations.
In fact, the American Society of Clinical Oncology (ASCO) released guidelines recommending PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.
Three PARP inhibitors have been approved to treat ovarian cancer:
- Niraparib (Zejula)
- Olaparib (Lynparza)
- Rucaparib (Rubraca)
The FDA most recently approved the PARP inhibitor niraparib for the maintenance treatment of women with ovarian cancer who had a partial or complete response to initial treatment with platinum-based chemotherapy.
In a study called PRIMA, using niraparib improved progression-free survival by about six months compared to a placebo (inactive treatment). Progression-free survival is the amount of time someone who’s received treatment lives with the cancer without it getting worse. The niraparib approval is not limited to women with a BRCA mutation, in contrast to FDA approvals for other PARP inhibitors. It’s approved for most women with late-stage epithelial ovarian cancer (the most common type of ovarian cancer) who’ve had a response to chemotherapy.
Not everyone with ovarian cancer responds the same way to treatment with PARP inhibitors, and this treatment is not recommended for all women. Women with a BRCA1 or BRCA2 mutation and those whose tumors express something called a homologous recombination deficiency profile (HRD) tend to respond best to this treatment.
There is incredible hope around PARP inhibitors and their potential when it comes to treating ovarian cancer. However, like all cancer drugs, certain side effects are possible.
Some of the most common side effects from this treatment are:
- Nausea
- Vomiting
- Upset stomach
- Fatigue
Your doctor will help you make a decision regarding maintenance therapy and whether it’s right for you.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Kristine Zanotti is a gynecologic oncologist at University Hospitals in Cleveland, Ohio. She's also an associate professor at Case Western Reserve University School of Medicine, and director of the gynecologic oncology fellowship at University Hospitals Cleveland Medical Center. Read More
Ovarian Cancer Recurrence: Need to Know
- Most women who undergo treatment for ovarian cancer will, unfortunately, experience a recurrence at some point.
- A regular blood test called CA-125 can monitor for recurrence.
- Maintenance therapy is used to try to prolong the remission time.
- A class of drugs called PARP inhibitors may be effective at delaying recurrence, especially in women with BRCA mutations.
Initial treatment for ovarian cancer usually involves a combination of surgery to remove as much of the cancer as possible, and chemotherapy. Although these treatments are very effective, most women who undergo them will, unfortunately, eventually experience a recurrence.
“Once we initiate ovarian cancer therapies, patients often wonder, how am I going to do with these treatments?” Dr. Kris Zanotti, a gynecologic oncologist at University Hospitals in Cleveland, tells SurvivorNet. “And I often tell them we get many, many clues along the way.”
Read More How well a woman’s body responds to treatment — and how long the cancer stays in remission — will depend on several factors, Dr. Zanotti says. Some of the clues that can indicate how well a woman is responding to treatment are:
- How well debulking surgery went — were all visible signs of cancer removed?
- How patients respond to chemotherapy, as measured by a CA-125 blood test
- How low CA-125 levels have dropped by the end of chemo treatments
Some women do experience cures from ovarian cancer treatment, but a large majority of patients will experience a recurrence. For that reason, women should discuss maintenance therapy with their doctors
“When a cancer recurs, we may have different goals in mind,” Dr. Zanotti says. “The management of treatment-related toxicities [and] quality of life become even more important than at the initial setting.”
Holding Off Recurrence
In an attempt to prolong remission and postpone recurrences for as long as possible, some women will be given the option to go on maintenance therapy, Dr. Zanotti says.
The U.S. Food and Drug Administration (FDA) has approved the use of PARP inhibitors for women who have completed initial cancer therapies. These drugs, given orally, work by preventing cancer cells from repairing their damaged DNA, which causes them to die. “PARP inhibitors are anticipated to be highly effective in ovarian cancer patients that have BRCA1 or BRCA2 mutations, in either their blood lines or in their tumor, in preventing and delaying recurrence,” Dr. Zanotti says. And studies are showing that PARP inhibitors are also effective — though to a lesser extent — in women without those genetic mutations.
In fact, the American Society of Clinical Oncology (ASCO) released guidelines recommending PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.
Three PARP inhibitors have been approved to treat ovarian cancer:
- Niraparib (Zejula)
- Olaparib (Lynparza)
- Rucaparib (Rubraca)
The FDA most recently approved the PARP inhibitor niraparib for the maintenance treatment of women with ovarian cancer who had a partial or complete response to initial treatment with platinum-based chemotherapy.
In a study called PRIMA, using niraparib improved progression-free survival by about six months compared to a placebo (inactive treatment). Progression-free survival is the amount of time someone who’s received treatment lives with the cancer without it getting worse. The niraparib approval is not limited to women with a BRCA mutation, in contrast to FDA approvals for other PARP inhibitors. It’s approved for most women with late-stage epithelial ovarian cancer (the most common type of ovarian cancer) who’ve had a response to chemotherapy.
Not everyone with ovarian cancer responds the same way to treatment with PARP inhibitors, and this treatment is not recommended for all women. Women with a BRCA1 or BRCA2 mutation and those whose tumors express something called a homologous recombination deficiency profile (HRD) tend to respond best to this treatment.
There is incredible hope around PARP inhibitors and their potential when it comes to treating ovarian cancer. However, like all cancer drugs, certain side effects are possible.
Some of the most common side effects from this treatment are:
- Nausea
- Vomiting
- Upset stomach
- Fatigue
Your doctor will help you make a decision regarding maintenance therapy and whether it’s right for you.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Kristine Zanotti is a gynecologic oncologist at University Hospitals in Cleveland, Ohio. She's also an associate professor at Case Western Reserve University School of Medicine, and director of the gynecologic oncology fellowship at University Hospitals Cleveland Medical Center. Read More
