As you start the often overwhelming process around planning your initial treatment, you will likely hear the phrase “standard of care.” This is the course of medical action to treat your disease, often, in significant part, dictated by guidelines created through an organization called the National Comprehensive Cancer Network, or NCCN.
Surgery for Ovarian Cancer
If doctors can safely remove your ovarian cancer, this is almost always, at least in consideration, as the first treatment step (please see more information on this decision making here.) SurvivorNet has extensive resources on this procedure, called “debulking.” Ovarian cancer is officially staged and graded through surgery to determine its extent.
Read More "The current treatment that we're going to give you, the standard treatment, is in existence because thousands of women have participated in studies," says Dr. Dana Chase, gynecologic oncologist at Arizona Oncology.
Chemo To Reduce The Amount of Ovarian Cancer
- With ovarian cancer, the standard of care (whether after surgery, or before) is a "very, very effective" chemotherapy. When ovarian cancer patients are diagnosed, according to Dr. Chase, they are usually given chemotherapy, which puts about 80% of patients into remission, at least for a period of time.
- Because the remission rate is so high, Dr. Chase says that she highly recommends her patients try the standard chemotherapy. The treatment, however, can be adjusted on an as-needed basis from woman to woman.
- The standard treatment for ovarian cancer is made up of two drugs working in combination for "initial chemotherapy" — Carboplatin and Paclitaxel. These treatments are typically given to a woman through an IV every three to four weeks, according to the American Cancer Society. The typical course of chemotherapy is made up of three to six treatment cycles based on what stage of cancer the patient has, but different drugs have different treatment cycles.
Treatment Right After Initial Treatments, or “Maintenance Therapy”
- A number of drugs are options for maintenance therapy, after the initial treatment. "We use some maintenance therapies with chemo and then continue them after chemo, such as Avastin while others we use after chemo, such as Olaparib," Dr. Chase says.
PARP Inhibitors For Maintenance Therapy
- A growing number of women diagnosed with epithelial ovarian cancer are eligible for treatment with a class of drugs called PARP inhibitors. PARP inhibitors are options for women as maintenance therapy after first chemotherapy or platinum sensitive recurrence, or as treatment for recurrence. The benefit a woman may see from this class of medication varies greatly, with the biggest determinant being the presence of an inherited or tumor mutation in BRCA.
How PARP Inhibitors Work
- One of the key things to know about PARP inhibitors is that your genetic makeup and specific features of your cancer will have a significant impact on how effective these drugs may be. Experts tell SurvivorNet that every woman with ovarian cancer should get a genetic test to determine if they have a mutation called BRCA, because the mutation enables PARP inhibitors to function much more powerfully. Importantly, there is increasing data that even women without BRCA mutations can still derive some benefit from these drugs.
- PARP inhibitors interrupt the process of single stranded DNA repair, an essential part of cell replication. Defects in DNA repair ultimately cause cell death. PARP inhibitors work best when there is a second error in DNA repair, such as that caused by a mutation in BRCA. BRCA is a critical player in homologous recombination, a highly effective double stranded DNA repair process. BRCA is not the only important part of homologous recombination, other genes are involved. A tumor that harbors homologous recombination deficiency (HRD) denotes a tumor with one of many possible errors in the double stranded DNA repair.
Quick Guide To PARP Use For Newly-Diagnosed Ovarian Cancer
- The PARP inhibitor Zejula (Niraparib) has been approved by the FDA for all women with newly-diagnosed ovarian cancer irrespective of whether the tumor is HRD. The drug is used after successful treatment with a platinum-based chemotherapy, the mainstay chemotherapy for ovarian cancer.
- Due to limited benefit in progression free survival seen in the absence of HRD, gynecologic oncologists differ on whether PARP inhibitors should be universally recommended in the "upfront maintenance setting." Each patient should be made aware of risks and benefits to PARP inhibitor maintenance and decide with their oncologist what is the best treatment plan for them.
- The PARP inhibitor Lynparza (Olaparib) is approved for women newly diagnosed with ovarian cancer and with a germline or somatic mutation in BRCA1/2.
- Lynparza is also approved in combination with Avastin (Bevacizumab) for women with HRD. Avastin is a blood vessel growth inhibitor, which works by starving the tumor of vital nutrients needed to grow.
Side Effects of Chemotherapy For Ovarian Cancer
It is important to note the side effects of chemotherapy, which can include: loss of hair, nausea, vomiting, loss of appetite, rashes on the hands and feet and mouth sores, according to the American Cancer Society. Chemotherapy can also impact the blood-forming cells of the bone marrow which can be cause for an increased risk of infections, bleeding and bruising or fatigue.
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