Clinically Speaking: Questions and Answers About Recurrent Ovarian Cancer

An ovarian cancer recurrence means the disease has returned after you’ve gone into remission or been declared disease-free. While survival rates for people with recurrent ovarian cancer are currently around 3 in 10, knowing your risks, advocating for yourself, and actively participating in your treatment and care can improve your outcome and your outlook.

We spoke with Blair McNamara, M.D., a gynecologic oncologist at Yale University School of Medicine and a member of HealthyWomen’s Women’s Health Advisory Council about recurrent ovarian cancer and its evolving treatment options.

​How likely is ovarian cancer to recur?

Recurrence rates of ovarian cancer depend on the stage of the tumor at diagnosis, your age and factors that tell us how aggressive the cancer is — the grade or histology. Most patients with high- grade ovarian cancer will get diagnosed with stage 3 or stage 4 disease. More than 7 out of 10 of these patients will experience a recurrence of their disease within the first five years.

Read: What You Need to Know About Ovarian Cancer >>

​Are there any racial or socioeconomic disparities that make certain people more likely to get recurrent ovarian cancer?

Unfortunately, yes. We know that in the United States, Black patients experience worse outcomes with ovarian cancer, including higher rates of recurrence. These worse outcomes are most likely the result of disparities in access to care, and access to clinical trials and the impact of structural racism.

Read: Black Women Have Some of the Lowest Rates of Ovarian Cancer — But Are Less Likely to Survive the Disease >>

​How is recurrent ovarian cancer treated?

Recurrent ovarian cancer can sometimes be treated surgically if you’ve had a six-month or longer disease-free period, and if the disease is not widespread. Otherwise, and even after surgery, recurrent ovarian cancer is treated with chemotherapy.

​What does platinum-resistant cancer mean?

Platinum-resistant ovarian cancer means a patient’s cancer has come back within six months of completing chemotherapy that included a platinum agent. Usually the agent is carboplatin, which works by preventing cancer cells from repairing or copying themselves.

​Is the treatment different for platinum-resistant cancer?

Yes. In platinum-resistant ovarian cancer, surgery is usually not considered and treatment with carboplatin is not offered. There are many other chemotherapies that can be used to treat platinum-resistant ovarian cancer, and many of them are newer, targeted therapies. We used to tell patients that chemotherapy is much less likely to work once they have platinum-resistant disease. However, that is no longer the case with these newer therapies, and treatment depends on a patient’s specific circumstance.

​What are biomarkers, and which biomarkers are connected to ovarian cancer and recurrence?

Biomarkers are measurable chemicals in the body that can indicate the presence or progression of ovarian cancer, as well as its response to treatment. A blood test for CA-125 is often used in patients with ovarian cancer, as it can help oncologists determine what your response will be to chemotherapy and detect recurrence of ovarian cancer. Tumors themselves can have different biomarkers that are identified after initial surgery. These biomarkers can influence therapy for both initial and recurrent ovarian cancer.

​How do the results of biomarker tests influence treatment options?

With new treatments for platinum-resistant ovarian cancer in development and approved by the Federal Drug Administration (FDA), certain tumor biomarkers suggest a patient’s cancer will respond to a targeted chemotherapy. These targeted therapies are becoming more common, and oncologists will determine what treatments you can have based on your tumor’s biology. For example, if tumors have homologous recombination deficiency, or HRD, patients may be eligible for certain oral maintenance treatment options to prevent the cancer from coming back.

​What factors should you consider when weighing your treatment options?

The first thing your provider will look at when determining your treatment options is the nature of your cancer. For example, the stage, grade, location and any biomarker information available to you. When making decisions about what treatment plan to proceed with, you should consider how well you tolerated chemotherapy during your initial treatment and discuss changes to your chemotherapy based on how well you tolerated the initial treatment. Be sure to think about any other health issues you have and what activities are most important to you, so you can prioritize them and discuss with your oncologist whether treatment side effects might get in the way of doing the things you love. You may also want to consider joining a clinical trial, which could make new treatments available to you.

This educational resource was created with support from Daiichi Sankyo.

This article was originally published on healthywomen.org.