Finishing your initial ovarian cancer treatment, which is usually a combination of chemotherapy and surgery, can be a big milestone, but unfortunately it often doesn’t mark the end of your cancer journey. As many as 80 percent of women may ultimately experience a recurrence, meaning that their cancer returns. “For many patients, that relapse comes one to two years after they complete their first therapies,” says Dr. Gillian Hsieh, gynecologic oncologist at Sutter Bay Medical Foundation in the Bay Area in California.
The likelihood of the cancer returning depends, in part, on its stage and grade. People who are diagnosed at stage I, when the cancer is confined to the ovaries, have a much lower chance of a recurrence than those who are diagnosed with a stage IV cancer, which has spread outside of the abdomen.
While a cancer’s stages are defined by location, the tumor’s grade describes its biology. A high-grade tumor has more abnormal cells, and tends to be more aggressive than a low-grade tumor, “and so it has a lot of opportunities to mutate and to overcome the effects of previously successful treatments,” Dr. Hsieh says.
The type of treatment you receive for a recurrence can depend on a number of factors. Two of the most important:
If the time between remission and recurrence is more than six months, then the ovarian cancer is categorized as platinum-sensitive, meaning it responded well to a platinum-based chemotherapy treatment in the past. In that case it’s likely that you’ll have chemotherapy again, using another platinum-based drug.
But if your recurrence happens less than six months into remission, the cancer is classified as platinum-resistant, and you’ll probably be treated with different drugs.
Secondary surgery is sometimes recommended after a recurrence, although that practice is becoming less popular as new studies are showing the surgery doesn’t improve survival for most women.
A number of promising new drugs have recently been FDA approved for ovarian cancer treatment, and some of them are specifically intended as maintenance therapies to lengthen the time before or to treat recurrences. One new class of drugs is called PARP inhibitors. These drugs work by preventing cancer cells from repairing their damaged DNA.
In clinical trials, another of the three PARP inhibitors, olaparib has been found to have a particular benefit for maintenance therapy when paired with bevacizumab (brand name Avastin). Bevacizumab works by cutting off the blood supply to tumors, effectively starving them. The FDA recently approved bevacizumab in combination with olaparib (brand name Lynparza) for women with a genetic marker called HRD (Homologous Recombination Deficiency) who show a response to platinum-based chemotherapy. The results of the trial showed an increase in progression-free survival from an average of 17 months to 37 months.
While the goal of initial cancer treatment is a long remission, after a recurrence the strategy changes to chronic disease management. “You’re continuously on treatment, but still able to continue some degree of your daily life,” Dr. Hsieh adds. During maintenance or treatment of a recurrence, your doctor will monitor you with regular exams and blood tests to see if or how your cancer is progressing.
The drugs used to treat ovarian cancer are very powerful, and often come with significant side effects. During maintenance you need to let your doctor know what you’re experiencing, so that you can balance the need to aggressively keep your cancer in check with your desire to maintain a good quality of life. Your doctor can offer options to deal with many drug side effects. Sometimes it’s as simple as reducing the dosage or switching to a similar drug that won’t have the same unwanted effects.
If your cancer has been deemed platinum resistant or your treatment isn’t slowing your cancer, you might want to consider enrolling in a clinical trial.These studies can be beneficial to you while also providing important information to the medical community about the effectiveness of potential treatments. Your doctor can recommend a clinical trial based on the individual disease factors that might make you a good candidate for a new drug or combination therapy.
When Ovarian Cancer Comes Back-- The Standard of Care Treatment
Recurrent Ovarian Cancer Treatment-- Is Your Disease "Platinum-Sensitive"?
Women with Recurrent Ovarian Cancer Are Living Longer on PARP Inhibitors
Fighting "Platinum Resistant" Ovarian Cancer
Weighing the Benefits of PARP Inhibitors
Managing Side Effects: Which PARP Inhibitor Is Right For Me?
Promising Immunotherapy Trials for Ovarian Cancer