Ovarian Cancer

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When Ovarian Cancer Comes Back – The Standard Care of Treatment

Dr. Rebecca Arend University of Alabama-Birmingham

In many cases, ovarian cancer does come back after initial treatment. While there are enormous emotional issues to handle, making good treatment decisions is, of course, crucial.

As part of initial treatment, most women get a so-called “platinum-based” chemotherapy. And this chemo is likely a part of the treatment for recurrence.

Women sometimes ask if they’re going to be treated with the precious, famously hard metal that we know as platinum. Certainly not! Simply put, platinum-based therapy is a drug composed of a chemical compound that includes  “metallic ions.” These ions have proven effective in fighting ovarian cancer cells.

Using Platinum-Based Chemo For Recurrence

Eventually, many women with ovarian cancer become resistant to platinum-based treatment, some faster than others Nevertheless, doctors are likely to keep trying platinum until it stops working, which can happen after the first round of treatment, or even the fifth round. Oncologists will keep trying platinum-based drugs until they don’t work anymore.

What is “Platinum Resistance?

If women recur within six months after completing platinum-based treatment, then they are deemed “Platinum Resistant,” and will likely be given another type of treatment, at least initially. Six months is somewhat of an arbitrary mark, but that is the time frame generally used as a benchmark by doctors. Patients who go more than six months after Platinum-based treatment without a recurrence are deemed “Platinum Sensitive,” which means they are responding well to platinum. Doctors are likely to continue platinum treatments in these patients.

Combining Platinum-Based Chemo with Taxol

Taxol is another drug that is usually given in initial treatment along with platinum-based drugs. In the case of a Platinum Resistant patient, a doctor might increase the dosage of Taxol, such as administering it weekly instead of every three weeks. Doctors may also use additional drugs such as Gemzar, Topotecan or Doxil with or without Avastin.

Adding Bevacizumab To Cut Off Blood Supply for Tumors

Any of these chemos drugs would likely be combined with a drug called Bevacizumab, known commercially as Avastin. This drug is a VEGF (Vascular Endothelial Growth Factor) inhibitor, which works by cutting off the growth of blood vessels to a tumor which helps reduce its growth. This process is known as anti-angiogenesis: blocking  angiogenesis, the physiological process through which new blood vessels are formed out of ones already in existence.

Avastin is particularly helpful for women with high-risk cases of ovarian cancer. This includes:

-Widely metastatic cases that could have spread to the other areas, such as the liver and chest.

-Cases where a tumor cannot be fully removed surgically.

-Women with recurrent ovarian cancer.

The drug has had a meaningful effect on recurrent cases that are both Platinum sensitive (six months after Platinum-based treatment) and Platinum resistant (within six months of Platinum-based treatment).

Women can continue using Avastin alone as maintenance after chemotherapy, as long as cancer doesn’t recur and the woman tolerates the drug well.

Adding PARP Inhibitors To Treatment for Recurrence

The reason Platinum is so effective in ovarian cancer treatment is similar to the reason why many women respond to PARP inhibitors. Both treatments target a cell’s ability to repair DNA, which prevents malignancies from repairing any DNA damage.

PARP inhibitors are becoming more widely used across the progression of ovarian cancer. They were first tested in women with recurrent ovarian cancer who also have the BRCA mutation. Women with the BRCA mutation have the greatest positive benefit from PARPs, though new evidence shows that using PARPs can extend life for many women.

Oncologists strongly recommend that women diagnosed with ovarian cancer undergo genetic testing to see if they carry a BRCA gene because it can help inform treatment decisions.

For more information, please consult SurvivorNet’s extensive resources on PARP Inhibitors.

 

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Dr. Rebecca Arend is an Associate Scientist at the University of Alabama-Birmingham (UAB) Comprehensive Cancer Center Experimental Therapeutics Program. Read More

Ovarian Cancer Recurrence

Most ovarian cancers that are treated will recur after a period of remission. Sometimes the cancer can go into remission again, then return repeatedly. Once her cancer returns, a woman will discuss with her doctor various options for new treatment, which include more rounds of chemotherapy, PARP inhibitors and participation in clinical trials.