Relapse and second line treatment
Although ovarian cancer is frequently controlled with
chemotherapy (that is, put into remission), and you feel fit and
well, the disease often returns. This is known as relapse, or
recurrence of the cancer. It is difficult to predict how long the
benefits of your treatment will last, as it varies in each
individual case. Some treatments may work for only a few months,
while other women have such a good response to chemotherapy that
they remain in remission for five years and beyond - and they are
cured.
If your ovarian cancer returns after initial ("first-line")
chemotherapy, it is often appropriate to use more (and different)
"second-line" drugs to achieve another remission. Some women may go
on to receive third-line or even fourth-line chemotherapy to
control the cancer.
The National Institute for Health and Clinical Excellence (NICE)
recommends that you are offered one of four types of treatment
depending on your circumstances.
You should be given time to discuss your treatment option with
your healthcare team, members of your family and others, such as
your GP if you wish.
What NICE recommends
NICE (National Institute for Health and Clinical Excellence)
advises the NHS. It produces guidance on the use of medicines and
when they should be used. It was set up to make sure you receive
consistently high quality treatment, wherever you live. NICE
guidance is relevant to England and Wales. In Scotland, the
Scottish Intercollegiate Guidelines Network produces guidance.
Northern Ireland does not have a similar organisation.
NICE guidance for the treatment of relapsed advanced ovarian
cancer depends on:
- how successful the first treatment was; and
- how long it has been since the first course of
chemotherapy.
Circumstances can be grouped into four scenarios:
- Platinum refractory ovarian cancer; this is cancer that has not
responded to first-line platinum based chemotherapy such as
carboplatin or cisplatin.
- Platinum resistant ovarian cancer; this is cancer that returns
within six months of finishing first-line platinum based
chemotherapy.
- Platinum sensitive ovarian cancer; this is cancer that has
responded to first-line platinum based chemotherapy but has
returned 12 months or morafter finishing first-line treatment.
- Partially platinum sensitive ovarian cancer; this is cancer
that had responded to first-line platinum based chemotherapy but
has returned between 6 and 12 months after finishing first-line
treatment.
These scenarios can be used to help you and your oncologist
decide which drugs to give you in second-line chemotherapy. Other
factors to be considered include:
- how you responded to the drug before;
- possible side effects;
- whether you have an allergy to platinum-based drugs; and
- the likely benefits of the drug.
Your oncologist should discuss the risks and benefits of each
treatment option with you before making any decision on second-line
or subsequent chemotherapy.
If you have any queries or wish to discuss these options before
making your decision , please call our nurse-led support line on
0845 371 0554. You may also wish to speak at greater length with
your oncology nurse.