Maintenance therapy for ovarian cancer
Maintenance therapy may be given to some women after they complete chemotherapy treatment to decrease the chance that the cancer will come back, or to delay the cancer from coming back. Two types of targeted therapies are used for maintenance therapy, Avastin (bevacizumab) and PARP inhibitors.
The choice of maintenance therapy for ovarian cancer depends on a few factors:
- Whether you were initially treated with chemotherapy alone or chemotherapy plus Avastin: Avastin may be used as maintenance therapy in women who received the drug as part of their initial treatment.
- How well your cancer responded to chemotherapy: maintenance therapy is used for women whose cancer disappeared (complete response) or shrank (partial response) during their most recent chemotherapy treatment.
- How many previous lines of chemotherapy treatment you have received: first-line or front-line is the first treatment given; second-line is used if the cancer returns; if the cancer comes back again, the next treatment regimen is called third-line, etc.
- Results of genetic testing for an inherited mutation: some maintenance therapy regimens are approved for women with an inherited mutation in BRCA1 or BRCA2.
- Results of tumor testing: some maintenance therapies are approved for women with a tumor mutation in BRCA1 or BRCA2 or a tumor biomarker called HRD-positive.
Avastin for maintenance therapy
Avastin (bevacizumab) may be used as maintenance therapy for women who received Avastin with chemotherapy as part of their initial treatment and had a complete or partial response. There are two ways that Avastin may be used for maintenance therapy:
- As first-line or later-line maintenance therapy used alone. Women do not need to have an inherited or tumor mutation or any type of biomarker test in order to receive maintenance treatment with Avastin alone.
- As first-line maintenance therapy combined with the PARP inhibitor Lynparza in women with a BRCA1 or BRCA2 inherited or tumor mutation or in women whose tumor is HRD-positive.
PARP inhibitors for maintenance therapy
PARP inhibitors are a type of targeted therapy that can be used as treatment or as maintenance after treatment. PARP inhibitors are only used for maintenance therapy to treat women who had a complete or partial response to their most recent treatment with chemotherapy. Three PARP inhibitors have received FDA approval for ovarian cancer maintenance therapy:
- Lynparza (olaparib)
- Rubraca (rucaparib)
- Zejula (niraparib)
- Lynparza may be used alone or in combination with Avastin as maintenance therapy for women with an inherited BRCA mutation or a BRCA mutation in their tumor.
- Lynparza may also be used in combination with Avastin (see above) for women whose tumor is HRD-positive.
- Zejula is approved to be used as maintenance therapy for any woman regardless of her BRCA or HRD status.
Second-line or higher
- Lynparza, Rubraca and Zejula may be used as maintenance therapy for women with ovarian cancer who have received two or more lines of chemotherapy who had either a complete or partial response to the most recent line of recurrence therapy. These PARP inhibitors may be given to women with or without a BRCA mutation, and regardless of their HRD status.
Table of FDA-approved maintenance therapies
|Line of therapy||Name of agent and how it is used||Biomarker or inherited mutation|
|First-line||Avastin alone for women who received Avastin with chemotherapy as treatment||No inherited or acquired mutation or other tumor biomarker needed|
|First-line||Avastin plus Lynparza for women who received Avastin with chemotherapy as treatment||Inherited BRCA1 or BRCA2 mutation or BRCA1 or BRCA2 tumor mutation|
|First-line||Avastin plus Lynparza for women who received Avastin with chemotherapy as treatment||HRD-positive|
|First-line||Lynparza alone||Inherited BRCA1 or BRCA2 mutation or BRCA1 or BRCA2 tumor mutation|
|First-line||Zejula alone||No inherited or acquired mutation or other tumor biomarker needed|
|Second-line or later||Lynparza, Rubraca or Zejula used alone||No inherited or acquired mutation or other tumor biomarker needed|
|Second-line or later||Avastin alone for women who received Avastin with chemotherapy as their most recent treatment||No inherited or acquired mutation or other tumor biomarker needed|