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Updated August 05, 2015.
In ovarian cancer, aggressive treatment (which includes surgery and chemotherapy) is often recommended by oncologists with the treatment goal of cure. Most women will have cancer which responds to this type of treatment. However, for many women, the ovarian cancer will recur at some point after primary treatment. The timing of this recurrence impacts treatment options that are available, and it also impacts prognosis.
Initial Treatment for Ovarian Cancer
It’s important to review the initial treatment for ovarian cancer. When you are newly diagnosed, you will likely be offered treatment with a combination of chemotherapy and surgery. Usually, the surgery comes first, followed by chemotherapy, but occasionally the surgery comes after some chemotherapy is given.
Ovarian cancer surgery typically includes removal of the uterus (i.e., hysterectomy), removal of the ovaries and the fallopian tubes (i.e., salpingo-oophorectomy), lymph node biopsies, removal of the omentum, and removal of as much ovarian cancer as possible (i.e., cytoreduction or debulking). And remember, ovarian cancer surgery should be performed by a gynecologic oncologist.
The recommended chemotherapy for ovarian cancer includes a platinum (such as carboplatin or cisplatin) and a taxane (such as paclitaxel or docetaxel). These are the drugs that have been shown to be most effective in the initial treatment of ovarian cancer. These drugs may be given intravenously or directly into the peritoneal cavity (i.e., intraperitoneal chemotherapy).
Recurrence After 6 Months From End of Therapy
If ovarian cancer comes back more than six months from when you received your last dose of chemotherapy with a regimen that included a platinum agent (cisplatin or carboplatin), the same or a similar treatment regimen can be given at the time of recurrence because the cancer typically remains sensitive to those initial drugs. This type of recurrence is called a platinum-sensitive recurrence, and the prognosis is better than if the recurrence happened sooner.
If you still have side effects from your initial treatment, however, it is important that you discuss these persistent side effects with your oncologist. A common side effect of Taxol (paclitaxel) is numbness and tingling of the fingers or feet, also called peripheral neuropathy. If you receive this drug again at the time of recurrence, your symptoms will likely worsen. Working with your oncologist to develop a customized treatment plan based on your past treatment and your current side effects is important.
Recurrence Within 6 Months From End of Therapy
If your ovarian cancer comes back within six months after your last dose of chemotherapy with a regimen that includes a platinum chemotherapy agent, your type of ovarian cancer recurrence is called a platinum-resistant recurrence. Because the recurrence happened soon after finishing initial treatment, using the original chemotherapy regimen is unlikely to be helpful in shrinking the cancer again. Prognosis is usually worse and the cancer tends to be less sensitive to chemotherapy treatments.
There are treatment options, however. Enrollment on a clinical trial is one of the best options, as it may allow treatment with a new and promising medication. If a clinical trial is not available in your area, however, other chemotherapy agents may be helpful. Some of these potential active agents include topotecan (Hycamtin), liposomal doxorubicin (e.g., Doxil), gemcitabine (Gemzar), and bevacizumab (Avastin).
Summary
It is important to work closely with your oncologist to determine the best treatment options available to you at the time of your ovarian cancer recurrence. If your recurrence occurs six months or later from the end of your initial treatment with a platinum, your treatment options are broader, and re-treatment with a platinum and a taxane (or similar drug) may be possible. If recurrence occurs less than six months from your initial treatment, the best treatment option is less clear and a clinical trial is an important option to consider.
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