Chemotherapy

Chemotherapy uses drugs that target and kill cancer cells after surgery. Most women with ovarian cancer get a platinum-based drug and a taxane as a first-line chemotherapy combined treatment.

Your gynecologic oncologist (or medical oncologist, for those who don’t have access to a gynecologic oncologist) will talk you through your options for chemotherapy.

The treatment that is best for you will depend on your exact cancer pathology, the staging of your cancer, and genetic and biomarker results, as well as your age, current health status, and pre-existing conditions.

Delivery Methods for Chemotherapy

Some chemotherapy is given through a vein (intravenous), some may be given directly into your abdominal cavity (intraperitoneal), and some is given by mouth (PO). Your doctor may discuss the option of having a catheter inserted surgically (called a Port) which can eliminate the need for multiple IVs or needles. 

A chemotherapy nurse will assist in providing your treatment and can also help alleviate any side effects. Every patient has a different response to chemotherapy, and side effects will depend on factors like the type and length of treatment.

Types of Ovarian Cancer Chemotherapy Drugs

There are several chemotherapy drugs used in varying combinations that you will hear as “standard” chemotherapy for common ovarian cancers. There are also newer drugs, used alone or in combinations with standard therapy, that are being studied via clinical trial, to determine if they produce the same or better results as the current standard treatment. Ask your doctor about your treatment, and why your team is recommending a specific treatment for you.

Platinum-Based Drugs (Cisplatin, Carboplatin)

Platinum-based drugs, such as cisplatin, (trade name Platinol) and carboplatin (trade name Paraplatin) have the chemical element platinum as part of their molecular structure. These drugs form highly reactive platinum complexes that bind and crosslink DNA, a double-stranded molecule inside the nucleus of the cell that controls cellular activity. The chemical crosslinking within the DNA prevents cancer cells from growing and causes them to die. Examples of platinum-based chemotherapy are carboplatin, cisplatin, and oxaliplatin.

Taxanes (Paclitaxel)

Taxanes include paclitaxel, (trade name Taxol) or docetaxel, (trade name Taxotere), and are a type of drug originally extracted from the Pacific yew tree, but now are chemically synthesized. Taxanes target microtubules, structures akin to internal highways inside cells. Taxanes prevent the microtubules from re-organizing themselves so cancer cells are no longer able to divide and grow. Paclitaxel and docetaxel are examples of taxanes.

Maintenance Therapy

Your doctor may recommend maintenance therapy options after you have completed your debulking surgery and chemotherapy protocol. It may reduce the risk or extend the time for cancer to return. Maintenance therapy may be an oral targeted therapy called PARP inhibitors such as Olaparib, Niraparib, or Rucaparib. Bevacizumab is another option that may be offered for maintenance.

The National Comprehensive Cancer Network (NCCN) 2023 Patient Guidelines recommend the following treatment for ovarian cancer patients:

Chemotherapy and Maintenance Therapy Side Effects

Side effects of chemotherapy depend on what medicine is being used, and in what dose, plus many other factors. Chemotherapy kills rapidly-growing cells, which includes not just cancer cells but also healthy cells in other parts of the body. Common side effects include low blood counts, fatigue, nausea, hair loss, neuropathy, mouth sores, and increased risk of infection.

Some people experience hypersensitivity (similar to an allergic reaction) to treatment. Please ask your doctor about what to expect, and what is considered a rare side effect or experience, so you and your loved ones can be aware of what to look out for.

For more information about the different standard chemotherapy treatment options, please visit pages 30-31 of National Comprehensive Cancer Network Patient Guidelines 2023. For more information about clinical trials near you, visit OCRA’s Clinical Trial Navigator.

Questions for Your Doctor About Chemotherapy

Here are some questions the National Cancer Institute suggests you might consider asking a doctor before you start chemotherapy:

• When will treatment start? When will it end? How often will I have treatment?
• Which drugs will I have?
• How do the drugs work?
• Do you recommend intravenous and intraperitoneal chemotherapy for me? Why?
• What are the expected benefits of treatment?
• Will I have a port placed for my treatment?
• What are the risks of treatment? What side effects might I have?
• How can I prevent or treat these side effects?
• How much will chemotherapy cost? Will my health insurance pay for all of the treatment?

Tips from our community about what to expect during and after chemotherapy

Participants in OCRA’s Woman to Woman peer support program and Staying Connected virtual support series share helpful tips below about dealing with chemotherapy treatment. You may not experience any or all of these described. And, always ask your health team before using any medications or homeopathic therapies.

• If you experience new symptoms and side effects, ask your doctor for help.
• Don’t be afraid to ask for help. Cancer is not a war, and you do not need to suffer to be successful in treatment.
• Using plastic utensils can mitigate the metallic taste some people get throughout treatment.
• It can be empowering to cut your hair short early.
• Remember to drink water or juice to stay hydrated throughout treatment.
• Walking and light exercise can make a big difference.
• Chew ice chips to prevent mouth sores.
• Using ice on your hands and feet can help with neuropathy.
• Acupuncture can be helpful for nausea, pain, trouble sleeping, and digestion issues.
• Ask for a prescription to help cover the cost of wigs. l
• A heating pad and Epsom salt baths can help with bone pain.  
• Participate in OCRA’s Staying Connected support series to find others in the community and process your experiences.