Ovarian Cancer: What Is Maintenance Treatment?

This article is for people who have ovarian cancer and their caregivers, or anyone who wants to learn more about ovarian cancer. The goal of this patient education activity is to help patients and caregivers engage in shared decision-making with their doctor about maintenance treatment for ovarian cancer.

You will learn about:

• What maintenance treatment for ovarian cancer is and its goal

• What medicines are used for maintenance treatment

• Finding the right maintenance treatment

• Questions to ask your doctor

All medicines listed in this activity are not FDA approved for ovarian cancer, but are recommended by the National Comprehensive Cancer Network (NCCN).

Ovarian cancer is a type of cancer that starts in the ovaries, a part of the female reproductive system. It often starts in the cells that form the outer layer of tissue around the ovaries.

Sometimes cancer cells can break away from where they first started and spread (metastasize) to other parts of the body. If this happens it's called metastatic ovarian cancer.

Surgery is often a first treatment for ovarian cancer. The 2 main goals of surgery are to remove all, or as much, of the cancer as possible, and to see if the cancer has spread.

Many women also get chemotherapy -- sometimes called "chemo" -- as treatment before or after surgery. Chemotherapy stops cancer cells from completing their life cycle so they can't increase in number.

Other treatments that may be used for ovarian cancer include targeted therapy, immunotherapy, hormone therapy, or joining a clinical trial.

Complete remission means that there are no signs of cancer after treatment. Partial remission means that the cancer has improved (deceased in amount or tumor size), but is not completely gone.

If one treatment doesn't work (or stops working) and cancer continues to grow or spread, other medicines may work. The second treatment is called second-line treatment, and the third is called third-line treatment. Which treatment your doctor recommends will depend on your overall health, other conditions you may have, what treatment you had before, any side effects from treatment, and your wishes and preferences.

Maintenance treatment is designed to continue (maintain) the good results of previous treatment. After chemotherapy, maintenance treatment is given to try to stop ovarian cancer from coming back.

The goal of maintenance treatment is to keep ovarian cancer under control for as long as possible after first treatment and to prevent or delay cancer from returning. Maintenance treatment may even turn a temporary remission into permanent remission.

There are 3 types of medicines that may be used as maintenance treatment:

• Certain chemotherapy

• Angiogenesis inhibitors, such as bevacizumab. This is targeted therapy that stops new blood vessels from forming around cancer cells. This keeps cancer cells from getting the blood they need to grow and survive

• PARP inhibitors, such as niraparib, olaparib, or rucaparib. This is targeted therapy that inhibits (blocks) a protein in cells called PARP. PARP is used by cells to repair damage to their DNA (the molecule in the cell that helps build it and keep it going). If a cancer cell is not able to repair its damaged DNA, it dies

Many factors can help find a maintenance treatment that may be right for you. In addition to what treatment you had before and your overall health, test results, other conditions, and preferences, your genes may help decide.

Genes inside your cells carry information that determines your inherited traits -- the features or characteristics passed on to you from your parents. Genes that have an abnormal change are called mutations.

Your doctor will do testing -- a genetic evaluation -- to check your genes for certain mutations before recommending a treatment.

One of the gene mutations your doctor will look for is in your BRCA1 or BRCA2 genes. These genes help prevent tumor growth by fixing damaged cells and helping cells grow normally. But mutations in these genes can prevent them from repairing damaged cells.

If you have BRCA1 or BRCA2 gene mutations, your doctor may recommend certain maintenance treatment, such as certain PARP inhibitors. When cancer cells have mutations in BRCA genes and can't repair their DNA, they have to rely on PARP to do it. And since PARP inhibitors block PARP from doing this job, the DNA doesn't get repaired and those cancer cells die.

It's important to know that there are many factors your doctor will look at when considering maintenance treatment.

If cancer continues to grow or spread during maintenance treatment, it's called persistent. Treatment for persistent ovarian cancer may include starting recurrence treatment, joining a clinical trial, or receiving supportive care to relieve cancer symptoms or treatment side effects and improve your quality of life.

Your doctor will discuss your options for treatment, including your personal preferences and wishes, if your cancer is persistent.

Questions you can ask your doctor about your ovarian cancer and treatment can include:

• Will I be getting maintenance treatment?

• What are the goals of treatment?

• What medicines are available, and what are their side effects?

• What's the best way to manage my symptoms and treatment side effects?

• How will I know if treatment is working?

• Is there a clinical trial that might be right for me?

• How can I make sure I have the best quality of life possible?

• Are there any lifestyle changes I should make?

• What should I do if I feel stressed or depressed?

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