Ovarian Cancer Treatment
Surgery and chemotherapy are the main treatments for ovarian cancer. The location and type of cells where the cancer begins, and whether the cancer is high-grade or low-grade, may influence the success of treatment. Surgery can cure most people with early-stage ovarian cancer that has not spread beyond the ovaries. For advanced ovarian cancer, the goal of surgery is to remove as much of the cancer as possible, called surgical debulking.
Platinum-based chemotherapy drugs, such as cisplatin or carboplatin (Paraplatin), often given in combination with other drugs, are usually effective in treating epithelial ovarian cancer at any stage. However, in most people with advanced ovarian cancer, the cancer usually comes back. Treating the cancer again with platinum drugs may work, but eventually the tumors become resistant to the drugs.
Targeted therapy uses drugs or other agents to attack specific types of cancer cells. PARP inhibitors are a type of targeted therapy that can stop a cancer cell from repairing its damaged DNA, causing the cell to die. Cancers in people who have certain mutations in the BRCA genes are considered particularly susceptible to PARP inhibitors. That’s because BRCA genes are involved in the repair of some types of DNA damage, so cancers with BRCA gene alterations already have defects in DNA repair.
The use of PARP inhibitors has transformed treatment for people with advanced epithelial ovarian cancer and harmful mutations in a BRCA gene. Since the 2014 approval of olaparib (Lynparza), the first PARP inhibitor, the number of PARP inhibitors has grown and their uses for people with ovarian cancer have expanded. For example, researchers are testing PARP inhibitors as maintenance therapy to prevent cancer from coming back or growing.
Clinical trials have shown that using PARP inhibitors as long-term therapy in women with advanced epithelial ovarian cancer delayed progression of the cancer.
Treatment after Cancer Progression
Typically, chemotherapy and targeted therapies are stopped once ovarian cancer begins to come back. But clinical trials for patients previously treated with the drug bevacizumab (Avastin) have found that resuming a treatment regimen with bevacizumab and a platinum-based chemotherapy even after the cancer started to grow again slowed the growth of platinum-sensitive disease. And in women who no longer benefited from platinum-based chemotherapy, non–platinum-based chemotherapy combined with bevacizumab kept the cancer in check longer than chemotherapy alone.
Researchers are also testing an experimental drug called adavosertib in women with relapsed or treatment-resistant ovarian cancer. Adavosertib blocks a protein in cells called Wee1 that helps regulate how cells grow and divide. In a clinical trial, combining adavosertib and gemcitabine improved how long women with recurrent or treatment-resistant epithelial ovarian cancer lived before their cancer got worse.
Targeted therapies may also be helpful for people with low-grade ovarian cancer. A trial of the drug trametinib in women with low-grade serous ovarian cancer that had come back showed that it delayed the cancer’s growth compared with treating the cancer with chemotherapy again.
Several clinical trials have studied the use of secondary surgery for women with advanced epithelial ovarian cancer that has come back after being in remission, or to remove more tumor after their initial surgery.
Hyperthermic Intraperitoneal (HIPEC) Chemotherapy
Doctors have used chemotherapy injected into the peritoneal cavity to treat ovarian cancer for decades. Now, researchers are studying the usefulness of infusing heated drugs directly into the peritoneal cavity in a procedure called HIPEC (hyperthermic intraperitoneal chemotherapy). HIPEC treatment involves washing the abdominal cavity with heated high-dose chemotherapy immediately after surgery to help kill any remaining cancer.
A large clinical trial found that people with stage 3 ovarian cancer treated with HIPEC during surgery lived almost a year longer than those who received only intravenous chemotherapy after surgery. Studies are underway to confirm this finding.
NCI-Supported Research Programs
Many NCI-funded researchers at the National Institutes of Health campus, and across the United States and the world, are seeking ways to address ovarian cancer more effectively. Some research is basic, exploring questions as diverse as the biological underpinnings of ovarian cancer and the social factors that affect cancer risk. And some is more clinical, seeking to translate this basic information into improving patient outcomes.
The Women’s Malignancies Branch in NCI’s Center for Cancer Research conducts basic and clinical research in breast and gynecologic cancers, including early-phase clinical trials at the NIH Clinical Center in Bethesda, Maryland.
The Ovarian Specialized Programs of Research Excellence (SPOREs) promote collaborative translational cancer research. This group works to improve prevention and treatment approaches, along with molecular diagnostics, in the clinical setting to help people with ovarian cancer.
The Ovarian Cancer Cohort Consortium, part of the NCI Cohort Consortium, is an international consortium of more than 20 cohort studies that follow people with ovarian cancer to improve understanding of ovarian cancer risk, early detection, tumor differences, and prognosis.
NCI’s clinical trials programs, the National Clinical Trials Network, Experimental Therapeutics Clinical Trials Network, and NCI Community Oncology Research Program, all conduct or sponsor clinical studies of ovarian cancer.