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 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 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.

What NICE recommends

The National Institute for Health and Care Excellence (NICE) 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 Medicines Consortium produces guidance. Northern Ireland does not have a similar organisation.

NICE recommends that you are offered one of four types of second-line treatment depending on your circumstances.

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 more after 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. You should be given time to discuss your treatment options with your healthcare team, members of your family and others, such as your GP if you wish.

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

Last review April 2016
Date of next review April 2018

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