Relapse and second line treatment

Although ovarian cancer is frequently controlled with chemotherapy, 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 for each individual. 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.

If your ovarian cancer returns after initial, first-line, chemotherapy, it is often appropriate to use a different second-line drug to achieve another remission. Some women may go on to receive third-line or even fourth-line chemotherapy to control the cancer.

Your second treatment will depend on how successful your first treatment was. This is judged by how long the cancer has taken to come back. Relapsed ovarian cancer is put into two different groups depending on how well it responded to first line treatment.

Group 1: Cancer that has come back less than 6 months after finishing first line platinum-based chemotherapy such as carboplatin or cisplatin. This is called platinum resistant cancer. If the cancer never responded to platinum based chemotherapy this is called platinum refractory ovarian cancer. In these situations your oncologist will discuss with you treatment options such as Taxol, Caelyx, or suggest you try new treatments that may be available in a clinical trial.

Group 2: Cancer that responded to first line platinum chemotherapy which has come back more than 6 months after the end of treatment. This is called platinum sensitive ovarian cancer. This is usually treated with platinum based chemotherapy plus another drug such as Taxol or Caelyx. Your doctor may suggest adding additional drugs that are available in a clinical trial.

You and your oncologist will need to consider other issues to decide second line treatment. These are:

How did your illness respond to the drugs before?

What are the drugs possible side effects?

Do you have an allergy to platinum based drugs?

What are the likely benefits of the second line drug?

Surgery

Research has shown that some women can benefit from having a second operation before having platinum based chemotherapy. These are women who have had all visible signs of ovarian cancer removed at their first surgery; their cancer returned more than 6 months after the end of their first line chemotherapy; they do not have ascites; and they are physically well.

For women in these circumstances a second surgery followed by chemotherapy can result in a significant delay in the cancer returning. It is not clear if a second operation will improve the overall outcome for women and the full results of the research have not yet been published.

Other treatments

Hormonal treatments such as tamoxifen and letrozole can control cancer by blocking hormones.

Targeted therapies such PARP inhibitors Olaparib and Niraparib work by interfering with the cancer’s DNA.

Avastin is a drug that interferes with the cancer’s blood supply.

 

You may also want to talk to your oncologist to see if there is a suitable clinical trial that you can take part in.

You may want to get a second opinion about your situation. Please call our support line 0800 008 7054 for more information on this.

If you have any queries or wish to discuss these options before making your decision , please call our  support line on 0800 008 7054. You may also wish to speak at greater length with your oncology nurse.

Last review April 2018
Date of next review April 2020

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