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Ovarian cancer

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Chemotherapy for ovarian cancer

Chemotherapy may be given after surgery for some types of ovarian cancer.

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to treat cancer. It is usually a systemic therapysystemic therapyTreatment that travels through the bloodstream to reach cells all over the body. that circulates throughout the body and destroys cancer cells, including those that may have broken away from the primary tumour.

Chemotherapy for ovarian cancer may be given intravenously (into a vein) or by intraperitoneal (IP) chemotherapy. During IP chemotherapy, drugs are injected directly into the space between the abdominal organs and the membrane lining the abdominal wall (peritoneal space or peritoneal cavity). This requires the surgical placement of a special intra-peritoneal port. The port allows the drugs to be safely delivered. The surgeon may place the port at the time of surgery for the ovarian cancer, or as a separate surgery.

When drugs are given during IP chemotherapy, they circulate and treat tumours throughout the abdomen. The drugs are also absorbed into the bloodstream, so IP chemotherapy is considered to be a type of systemic chemotherapy. IP chemotherapy is given in addition to intravenous chemotherapy.

Chemotherapy may be used:

  • after surgery to destroy cancer cells left behind and to reduce the risk of the cancer recurring (adjuvantadjuvantTreatment given in addition to the first-line therapy (the first or standard treatment) to help reduce the risk of a disease (such as cancer) coming back (recurring). chemotherapy)
  • to relieve pain or to control the symptoms of advanced ovarian cancer (palliative chemotherapy)

Drugs, doses and schedules vary from woman to woman.

Epithelial ovarian cancer

Chemotherapy is commonly used to treat epithelial ovarian cancer.

The most common chemotherapy drugs used to treat epithelial ovarian cancer are the platinum drugs:

  • carboplatin (Paraplatin, Paraplatin AQ)
  • cisplatin (Platinol AQ)

The most common chemotherapy combinations used to treat epithelial ovarian cancer include a platinum drug and a taxane, such as:

  • carboplatin and paclitaxel (Taxol)
  • carboplatin and docetaxel (Taxotere)
  • cisplatin and paclitaxel

Secondary chemotherapy

Different drugs (secondary chemotherapy) may be given if epithelial ovarian cancer does not respond to carboplatin, cisplatin or a combination of these drugs with a taxane. Secondary chemotherapy is also given if epithelial ovarian cancer recurs.The type of drug used for secondary chemotherapy will depend on if the cancer is platinum-sensitive, platinum-refractory or platinum-resistant.

  • Platinum-sensitive tumours respond to the platinum drugs. If the cancer recurs, it comes back more than 6 months after the end of treatment.
  • Platinum-refractory tumours do not respond during the first chemotherapy treatment.
  • Platinum-resistant tumours recur less than 6 months after the end of treatment.

Recurrent epithelial ovarian cancer will be treated with a combination of drugs.

  • Platinum-sensitive recurrent epithelial ovarian cancer will be treated with a combination of drugs, including a platinum drug again.
  • Platinum-refractory or platinum-resistant recurrent epithelial ovarian cancer will be treated with other drugs. The most common drugs are:
    • docetaxel (Taxotere)
    • paclitaxel (Taxol)
    • etoposide (Vepesid)
    • gemcitabine (Gemzar)
    • topotecan (Hycamtin)
    • vinorelbine (Navelbine)
    • pegylated liposomal doxorubicin (Caelyx)
    • trabectedin (Yondelis)
    • bevacizumab (Avastin)

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells.

Olaparib (Lynparza) is a type of poly ADP ribose polymerase (PARP) inhibitor. PARP is a group of proteins that helps repair damage to DNA. PARP inhibitors block PARP in cancer cells, causing them to die. This treatment may be offered to women who have epithelial ovarian cancer with BRCA1 gene mutations that has responded to platinum-based chemotherapy. It is given by itself to stop or slow the cancer from recurring (called maintenance therapy).

Intraperitoneal (IP) chemotherapy

IP chemotherapy may be offered to women with stage III epithelial ovarian cancer who still have tumours smaller than 1 cm in size after primary surgical debulking. For the chemotherapy to be effective, there can only be a small amount of cancer left in the abdomen.

  • Cisplatin is the drug most often used in IP therapy.
  • IP chemotherapy causes severe side effects, so it may not be a treatment option for all women.
  • Doctors will consider the woman’s performance status, kidney function and amount of scar tissue (adhesions) when deciding if IP chemotherapy is an option.

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Ovarian stromal tumours

Chemotherapy is used less often to treat ovarian stromal tumours. When it is given, the most common chemotherapy combinations used are:

  • carboplatin (Paraplatin) and paclitaxel (Taxol)
  • PEB (or BEP)
    • cisplatin (Platinol AQ)
    • etoposide (Vepesid)
    • bleomycin (Blenoxane)
  • PVB
    • cisplatin
    • vinblastine (Velbe)
    • bleomycin
  • CAP
    • cyclophosphamide (Cytoxan)
    • doxorubicin (Adriamycin)
    • cisplatin
  • VAC
    • vincristine (Oncovin)
    • dactinomycin (Cosmegen, Actinomycin-D)
    • cyclophosphamide

Hormonal therapy is often used to treat ovarian stromal tumours. If an ovarian stromal tumour does not respond to chemotherapy or hormonal therapy drugs used in earlier treatments, or if it recurs, another combination of drugs may be used.

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Ovarian germ cell tumours

Chemotherapy is commonly used to treat ovarian germ cell tumours.

The most common chemotherapy combinations used to treat ovarian germ cell tumours are:

  • PEB (or BEP)
    • cisplatin (Platinol AQ)
    • etoposide (Vepesid)
    • bleomycin (Blenoxane)
  • carboplatin (Paraplatin) and etoposide

If the ovarian germ cell tumour does not respond to drugs used in earlier treatments or if it recurs, other drugs that may be used are:

  • VeIP
    • vinblastine (Velbe)
    • ifosfamide (Ifex)
    • cisplatin
  • TIP
    • paclitaxel (Taxol)
    • ifosfamide
    • cisplatin
  • VIP
    • etoposide
    • ifosfamide
    • cisplatin

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Extra-ovarian primary peritoneal carcinoma

Chemotherapy is commonly used to treat extra-ovarian primary peritoneal carcinoma. The same chemotherapy drugs and combinations of drugs used to treat epithelial ovarian cancer are used to treat extra-ovarian primary peritoneal carcinoma.

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For more detailed information on specific drugs, go to sources of drug information.

See a list of questions to ask your doctor about chemotherapy.

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