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.
Types of Ovarian Cancer Chemotherapy Drugs
Some patients may receive chemotherapy before having surgery to remove their tumors. This is known as neoadjuvant chemotherapy.
More typically, chemotherapy is used to treat patients after surgery. Patients will usually receive either systemic chemotherapy, or a combined systemic chemotherapy and intraperitoneal therapy. Besides the gynecologic oncologist (or medical oncologist, for those who don’t have access to a gynecologic oncologist) taking care of you, a chemotherapy nurse will assist in providing the drug treatment that will attempt to kill remaining cancer cells in the body. The chemotherapy nurse is a very important health care professional in a patient’s life, because they will assess the side effects of the drugs and help to alleviate them. Side effects are common with chemotherapy and depend on the type and length of treatment. Every patient has a different response to chemotherapy. The doctor and nurse will explain possible side effects, and provide suggestions and treatments for managing side effects.
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.
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 reorganizing themselves so cancer cells are no longer able to divide and grow.
Delivery Methods for Chemotherapy
Chemotherapy is delivered in cycles, with each treatment period followed by a rest period. How the chemotherapy is delivered depends on the stage of the disease and how much of the tumor was removed.
The success rate for ovarian cancer chemotherapy in removing all traces of cancer depends on the type of tumor being treated, as well as stage at diagnosis, and more. Likewise, each patient’s chemotherapy regimen is individualized, and will also depend on the type and stage of ovarian cancer, as well as factors like overall health, past effectiveness of chemotherapy treatments, and more. In general, patients can receive chemotherapy for ovarian cancer multiple times in cases of recurrence, though effectiveness may decrease and different drugs and regimens may be needed.
Intraperitoneal Chemotherapy
Intraperitoneal chemotherapy, or IP chemotherapy, is done through a surgically implanted catheter in the peritoneum, or abdominal cavity, to destroy cancer located in the abdomen or pelvis. The catheter inside the abdominal cavity is connected to a port, which the surgeon situates between a rib and abdominal muscle. The port has a chamber outside of the skin for delivery of drugs, which then enter the catheter to wash over internal organs. Some of the drug also diffuses into the bloodstream.
While IP chemotherapy has been in use since the 1950s, new advances have combined it with intravenous (IV) therapy, using chemotherapy agents that work best for treating ovarian cancer. The National Cancer Institute recommends that, for select ovarian cancer patients, chemotherapy be given by both IV and IP. This combination has been found to increase survival for women with advanced stage ovarian cancer.
Systemic Chemotherapy
Systemic chemotherapy is done by mouth or intravenously, through the vein to destroy or control cancer throughout the body.
Why Experts Recommend a Combined Approach to Chemotherapy
In January 2006, the National Cancer Institute announced that it was now recommending both systemic intravenous and intraperitoneal chemotherapy for certain women with advanced ovarian cancer, particularly women with stage III cancer whose tumor was debulked to less than one centimeter in size or had no visible sign of the disease. Approximately 60 percent of women diagnosed with ovarian cancer have stage III disease. The combined approach, with intraperitoneal treatment after intravenous drug therapy, is more toxic, with more side effects, but extends overall survival for women with advanced ovarian cancer by about a year compared to intravenous delivery alone.
Although many women have trouble completing all the chemotherapy rounds with the combined intravenous and intraperitoneal treatments, whatever they can withstand is still thought to be effective. Doctors believe that intraperitoneal therapy works by bringing the toxic drugs in a more concentrated form closer to the site of the disease and are therefore more effective at killing the cancer cells. Intravenous therapy, being more systemic, aims to kill cancer cells wherever they might be located in the body.
Women with earlier stage disease and women with cancers that cannot be reduced to less than one centimeter in size usually get intravenous chemotherapy with a platinum-based drug and a taxane.
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.
- Expectations around chemotherapy- scary unknown- but not everyone experiences all side effects
- If experiencing symptoms that are not normal for you, ask your doctor for help your symptoms.
- Cancer is not a war- you do not need to suffer to be successful in treatment
- You may experience a metallic taste. Plastic utensils can help if you have bad taste during treatment
- Smaller meals
- Cut hair short prior to hair loss
- Explore psychological and physical support programs available to you
- Drink water before and after treatment (ask your medical team the amount of water that is right for you) – some use fruit juice or flavor to help make the water taste better
- Walk, walk, walk
- Chew ice chips- helps prevent mouth sores
- Some people use ice for hands/feet to prevent neuropathy, some use supplements which help
- Acupuncture for nausea, pain, sleeping, digestion, and healing can help some
- Ask for prescription for wig to help cover cost or ACS has program that may be helpful
- Bowel changes after chemo- constipation
- Bone pain – heating pad and Epsom salt bath helped me
- It helped being part of Staying Connected. I learned a lot and trusted the people in my group.
- Relationships may change- transition period- getting to know the new you.
- Coming off therapy can be a surprising challenge both physically and emotionally, some depression.
Research Studies on Ovarian Cancer and Chemotherapy Funded by OCRA
- Nidhi Sahni, PhD, MD Anderson Cancer Center, “Systems Approach for PARP-based Novel Combination Therapy for Ovarian Cancer”
- Shariska Petersen, MD, University of Kansas Medical Center Research Institute, “Cyclin E and BRDR as Markers for a New PARPi Drug Combination”