Maintenance Therapy for Ovarian Cancer

Maintenance therapy may be recommended for some people with ovarian cancer who have already completed their initial treatment. This is therapy that is given to help prevent or delay your cancer from coming back (known as recurrence).1

When is maintenance therapy needed?

Maintenance therapy is standard treatment for different types of cancer. This includes certain types of ovarian cancer after other forms of treatment.2,3

Your doctor may recommend that you have maintenance therapy even if your cancer disappeared after your initial treatment (known as complete response). Maintenance therapy may also be used in people whose cancer shrank but did not go away after treatment (partial response). This can reduce the chances of the cancer coming back or delay its return.1-3

Ovarian cancer recurrence

Researchers estimate that around 70 percent of people diagnosed with ovarian cancer will have their cancer come back at some point. The stage at diagnosis has a large impact on the likelihood of the cancer returning:4

  • People diagnosed in stage I have a 10 percent chance of their cancer returning
  • People diagnosed in stage II have a 30 percent chance of their cancer returning
  • People diagnosed in stage III have a 70 to 90 percent chance of their cancer returning
  • People diagnosed in stage IV have a 90 to 95 percent chance of their cancer returning

Ovarian cancer that returns after treatment is rarely curable. However, it is treatable. This means that preventing or delaying it from returning is ideal.4

What drugs are used for ovarian cancer maintenance therapy?

As of early 2021, there are 4 drugs that are used for ovarian cancer maintenance therapy. These include 1 targeted therapy drug, Avastin® (bevacizumab), and 3 PARP inhibitor drugs. These are Lynparza® (olaparib), Rubraca® (rucaparib), and Zejula (niraparib).2

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Several factors will determine which maintenance therapy drug your doctor will recommend. This includes:2

  • Results of your tumor or genetic testing
  • How many forms of chemotherapy you received
  • How well your cancer responded to chemotherapy
  • Your initial treatment

Avastin

Avastin (bevacizumab) is generally used as maintenance therapy for people who received this drug with chemotherapy during initial treatment and their cancer disappeared or shrank.2

Bevacizumab can be used alone to treat certain types of ovarian cancer as a first-line or maintenance therapy. People do not need a genetic or tumor mutation or biomarker test to receive it.2

Bevacizumab can also be used as first-line maintenance therapy combined with Lynparza (olaparib) in people whose ovarian cancer tumor is homologous recombination deficiency (HRD) positive.2

PARP inhibitors

Three PARP inhibitors are used for maintenance therapy in certain forms of ovarian cancer:2

  • Lynparza (olaparib)
  • Rubraca (rucaparib)
  • Zejula (niraparib)

These drugs are generally used for maintenance therapy in people whose cancer disappeared or shrank following their most recent treatment with chemotherapy. The drugs may also be used in active treatment for some types of ovarian cancer.2

The specific PARP inhibitor used for ovarian cancer maintenance therapy depends on several factors. These include previous treatments and whether you have a genetic or tumor mutation.

How long does maintenance therapy last?

The goal of maintenance therapy is to try to reduce the risk of ovarian cancer from coming back as much as possible. The length of your therapy can vary depending on the drug you are taking and how well you respond to it.

Talk with your doctor about what your maintenance therapy plan looks like and what it will mean for you. If your cancer returns or worsens while on maintenance therapy, your doctor will talk to you about your treatment options.

What are the side effects?

Side effects can occur with any drug, including those used in maintenance therapy. Side effects can vary depending on the specific drug you are taking.

The most common side effects of bevacizumab include:5

  • High blood pressure
  • High levels of protein in the urine
  • Nosebleeds
  • Back pain
  • Headache
  • Changes in how things taste
  • Dry skin

The most common side effects of the PARP inhibitor drugs olaparib, rucaparib, and niraparib include:6

  • Nausea and vomiting
  • Changes in how things taste
  • Diarrhea
  • Fatigue
  • Anemia
  • Muscle and joint pain

Some people have developed blood cancers after treatment with PARP inhibitors, but this is rare.6

These are not all the possible side effects of maintenance therapy drugs. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with maintenance therapy.

Things to consider

If you have advanced ovarian cancer, talk with your doctor about maintenance therapy and its role in your treatment plan. It is not a guarantee that the cancer will not return. However, it can increase the chances of delaying or preventing your cancer from coming back.

Before beginning maintenance therapy for ovarian cancer, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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Written by: Jaime Rochelle Herndon | Last reviewed: May 2021