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Risk Management & Treatment

for ovarian cancer

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 , Avastin (bevacizumab) and PARP inhibitors.

The choice of 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 in women who received the drug as part of their initial treatment.  
  • How well your cancer responded to chemotherapy:  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 regimens are approved for women with an inherited mutation in or .
  • Results of tumor testing: some maintenance therapies are approved for women with a tumor mutation in or or a tumor called HRD-positive.


Avastin for

Avastin (bevacizumab) may be used as  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 used alone. Women do not need to have an inherited or tumor mutation or any type of in order to receive maintenance treatment with Avastin alone. 
  • As first-line combined with the Lynparza in women with a or inherited or tumor mutation or in women whose tumor is HRD-positive. 


PARP inhibitors for 

PARP inhibitors are a type of that can be used as treatment or as maintenance after treatment. PARP inhibitors are only used for to treat women who had a complete or partial response to their most recent treatment with chemotherapy. Three PARP inhibitors have received  approval for ovarian cancer maintenance therapy:

  • Lynparza (olaparib)
  • ()
  • ()


First-line:

  • Lynparza may be used alone or in combination with Avastin as  for women with an inherited mutation or a  mutation in their tumor.
  • Lynparza may also be used in combination with Avastin (see above) for women whose tumor is HRD-positive. 
  • is approved to be used as for any woman regardless of her or status. 


Second-line or higher 

  • Lynparza,  and  may be used as  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  mutation, and regardless of their status. 


Table of FDA-approved maintenance therapies

Line of therapy Name of agent and how it is used or inherited mutation   
First-line Avastin alone for women who received Avastin with chemotherapy as treatment No inherited or acquired mutation or other tumor needed 
First-line Avastin plus Lynparza for women who received Avastin with chemotherapy as treatment Inherited or mutation or or tumor mutation
First-line Avastin plus Lynparza for women who received Avastin with chemotherapy as treatment HRD-positive
First-line Lynparza alone Inherited or mutation or or tumor mutation
First-line alone No inherited or acquired mutation or other tumor needed 
Second-line or later Lynparza, or used alone No inherited or acquired mutation or other tumor 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 needed 

 

Last updated January 23, 2022

Expert Guidelines
Expert Guidelines

The following NCCN recommendations are for for women with ovarian cancer who have had a complete or partial response to first-line therapy:

  • Women who have a mutation may benefit from a as .
  • Women who have a mutation and had Avastin as part of their first-line treatment may benefit from a alone or Lynparza and Avastin as .
  • Women who do not have a mutation and had Avastin as part of their first-line treatment may benefit from a alone or in combination with Avastin as , depending on their status.
  • Women who do not have a mutation and did not have Avastin as part of their first-line treatment may benefit from a as .

updated: 12/07/2021