Recurrence & Maintenance

Recurrence & Maintenance

Living With Recurrent Ovarian Cancer

Every year, approximately 22,000 women are newly diagnosed with ovarian cancer in the US.1 The majority of women are diagnosed with advanced stage disease while only about 20 percent of women are diagnosed while their disease is still in early stages.2 For some, the cancer may respond to initial treatment with chemotherapy and the time in remission may last for years,1 although that doesn’t always mean the cancer has been cured.But for the majority of women, the cancer comes back,2 either in the same area as the original cancer or somewhere else in the body.This is called a recurrence.5 Unfortunately, recurrence in ovarian cancer is common. Women with advanced ovarian cancer face an 85 percent likelihood of recurrence after their initial chemotherapy treatment. Once ovarian cancer recurs, it is considered incurable.6

The possibility of recurrence can be scary. It can leave women feeling uncertain about what to do next, even if they are in remission with no evidence of disease. Understanding what recurrence means is an important step in choosing the right treatment plan and managing the emotions that come along with it.

Hear members of the community discuss the possibility of recurrence in ovarian cancer.

Once ovarian cancer recurs, the objective is clear: to extend the time between future recurrences.

After a woman has been retreated with chemotherapy and her disease has responded (partially or completely), there are two different treatment approaches to take: observe the disease, also referred to as “watch and wait,” or “maintenance” treatment to extend the time it takes before cancer progresses or returns.

Observation or “Watch and wait”

An option for women after their cancer has fully or partially responded to chemotherapy is to observe the disease, or “watch and wait.”7 This approach involves regular doctor visits for tests to monitor disease, rather than taking medicine.8 When cancer returns, women and their doctors discuss their options and initiate further treatment.

Maintenance treatment

While observation or “watch and wait” was previously standard practice, there are now new treatment options available for physicians and women with ovarian cancer to become more proactive in their approach to managing the disease. Maintenance treatment is available for women whose cancer has returned and who have achieved a complete or partial response to chemotherapy.9 Front Line maintenance treatment is also available for women with a BRCA mutation and who have achieved a complete or partial response to platinum-based chemotherapy.

Several maintenance treatment options can help extend the time between potential recurrences,

also known as progression-free survival, for women with recurrences and whose disease has either fully or partially responded to chemotherapy.

Without Maintenance, PFS Shortens With Each Recurrence15

Chart depicting the median time between each recurrence of ovarian cancer with treatment of chemotherapy and observation

PFS, progression-free survival.

PFS was calculated from the day of first cycle of chemotherapy to the first disease progression; thereafter, it was calculated from the progression to subsequent progression or death.15

Maintenance treatment options

There are currently 2 FDA-approved classes of maintenance treatments available for women with ovarian cancer, regardless of mutation status:

Poly(ADP-ribose) polymerase (PARP) inhibitors:10,11
  • PARP is a protein that helps repair damaged DNA in cells 
  • A PARP inhibitor may prevent cancer cells from repairing their damaged DNA, which can cause them to die. This may slow the return or progression of cancer. It can also impact other cells and tissues in the body
Vascular endothelial growth factor (VEGF) inhibitors:12
  • Normal cells make VEGF, but some cancer cells make too much VEGF
  • Blocking VEGF may prevent the growth of new blood vessels, including normal blood vessels and blood vessels that feed tumors

Companies are also investigating new maintenance therapies:

  • PARP inhibitors in combinations with other biological drugs13
  • Immunotherapy combination regimens that include PD-1/L1 inhibitors14

Without a maintenance treatment, progression-free survival shortens with each recurrence. Talk to your doctor about the possibility of extending your time in response and to understand if a maintenance treatment option is right for you.

Starting a conversation

The questions below can help kick-off meaningful discussions about recurrence and maintenance with your healthcare team.

  • Why would my cancer recur and what are my chances of recurrence?
  • Are there symptoms I should look for that would signal a recurrence?
  • How frequently should I come in for check-in visits to monitor my disease?
  • What do I need to know about maintenance treatments? How do they work?
  • Is taking a maintenance treatment right for me?
  • What are my options if my cancer recurs?

Want more help starting discussions with your healthcare team?

Download the Ovarian Cancer Discussion Guide