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Risk Management & Treatment

Biomarkers, targeted and immunotherapies for , ovarian and primary peritoneal cancer

This section covers the following topics:


Genetic tests for inherited mutations for treatment selection

Genetic testing for an inherited mutation may be used to guide treatment selection for people diagnosed with ovarian cancer.  

  • People with advanced recurrent ovarian cancer who test positive for an inherited or mutation may benefit from treatment with a type of known as a .
  • People who test positive for other inherited gene mutations may qualify for clinical trials looking at targeted therapies to treat hereditary ovarian cancer. 
  • People who test positive for a gene mutation may benefit from treatment with an agent. 


testing 

tests look at samples of blood, tumor or other tissue for changes or abnormalities caused by cancer. These tests can give doctors clues about the cancer, including:

  • how fast the cancer is growing
  • which treatments are most likely to work
  • whether or not the cancer is responding to treatment or growing
  • whether or not the cancer has come back after remission

tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. tests used to select a specific treatment are sometimes called companion diagnostic tests. These tests may be done on tumor tissue or (in many cases) on blood. See our Testing section for more information. 


Biomarkers for treatment selection

Examples of tests used in , ovarian and primary peritoneal cancer include:

  • Tests can be done to look for  or gene mutations in the tumor. Women who test positive for a or mutation in their tumor may benefit from a type of therapy known as a . A tumor test positive for a  or mutation in one of two situations:, 
    • when women who have an inherited mutation in or develop ovarian cancer, their tumor is very likely to display the same mutation.
    • women who test negative for an inherited mutation in or may still develop an acquired  mutation in their tumor. Women with a mutation in their tumor may also respond well to treatment.  
  • Some ovarian cancers will have an abnormality known as ( high") also known as "" ( or ). cancers are common in people with a gene mutation. These cancers may respond well to a type of treatment known as an immune checkpoint inhibitor. One example of an agent used for MSI-H cancers is Keytruda (pembrolizumab).


Biomarkers to monitor recurrence or response to treatment

CA125 is a type of protein that is produced in large amounts by some ovarian cancers. Doctors may use CA125 blood tests monitor recurrence or response to treatment. 


Immunotherapies 

Immunotherapies are cancer treatments that hlep the body’s immune system detect and attack cancer cells. There are several different categories of immunotherapies. 

  • Keytruda (pembrolizumab) is known as an immune checkpoint inhibitor. approved for treatment of patients with cancer that tests . Although this is not common in ovarian cancer, it is often seen in people with a gene mutation who develop cancer. 


Targeted therapies

Two types of targeted therapies are commonly used to treat advanced ovarian cancer:

  • Avastin (bevacizumab)
  • PARP inhibitors


Avastin

Avastin is a that works by cutting off the blood supply to the cancer. It may be given as treatment in combination with chemotherapy, or as  after treatment alone or in combination with Lynparza.


PARP inhibitors 

PARP inhibitors work by blocking a protein used by cells to repair damaged . They were initially developed to treat cancers in people with an inherited gene mutation or mutation. Three PARP inhibitors have been approved for treating ovarian cancer:

  • Lynparza (olaparib)
  • ()
  • ()

PARP inhibitors have received approval for treating ovarian cancer in two settings:

  • as treatment of advanced, recurrent ovarian cancer
  • after chemotherapy as  for advanced ovarian cancer

Research is ongoing to learn if PARP inhibitors are also affective for treating ovarian cancer in other situations, including:  

  • people with an inherited mutation in a different gene that repairs damage (for example: , , , ).
  • people who do not have an inherited gene mutation, but tumor testing found an acquired tumor mutation in a gene that repairs damage.
  • in combination with or other agents.


PARP inhibitors for treatment of advanced, recurrent cancer

  • For treating people with advanced, recurrent ovarian cancer, two PARP inhibitors have received FDA-approval as for treating people with a mutation. The two approved drugs are:
    • Lynparza (olaparib)
    • ()


 is given after chemotherapy to try to keep the cancer from returning. The goal is to extend the length of time before recurrence or to turn remission into a long-term cure. 

Table of targeted and immunotherapies for , ovarian and primary peritoneal cancer

Name of drug Type of agent Line of therapy Indication
Avastin
(bevacizumab)
Monoclonal antibody targeting vascular endothelial growth factor (VEGF) First-line maintenance Combined with Lynparza (olaparib) for platinum-sensitive cancer  
() testing
Avastin
(bevacizumab)
Monoclonal antibody targeting vascular endothelial growth factor (VEGF) First-line Combined with chemotherapy, followed by Avastin as a single agent following initial surgical resection No required
Avastin
(bevacizumab)
Monoclonal antibody targeting vascular endothelial growth factor (VEGF) Second or third-line Combined with chemotherapy for platinum-resistant recurrent disease  No required
Avastin
(bevacizumab)
Monoclonal antibody targeting vascular endothelial growth factor (VEGF) Second-line or later Combined with chemotherapy, followed by Avastin as a single agent, for platinum-sensitive recurrent diesase No required
Lynparza
(olaparib)
First-line maintenance For women who had a complete or partial response to platinum chemotherapy Inherited or acquired (tumor) mutation in or
Lynparza
(olaparib)
First-line maintenance Combined with Avastin (bevacuzimab) for women who had a complete or partial response to platinum chemotherapy  
() testing
First-line maintenance For women who had a complete or partial response to platinum chemotherapy No inherited or acquired mutation or other tumor
biomarker needed

Lynparza
(olaparib)


()


()

Second-line or later maintenance For platinum-sensitive or partially sensitive recurrent cancer  No inherited or acquired mutation or other tumor
biomarker needed

()
Third-line or later treatment For treatment of advanced, recurrent ovarian cancer Inherited or acquired (tumor) mutation in or
Lynparza
(olaparib)
Fourth-line or later treatment For treatment of advanced, recurrent ovarian cancer Inherited mutation in or

()
Fourth-line or later treatment For treatment of advanced, recurrent ovarian cancer mutation or
HRD-positive
Keytruda (pembrolizumab) Immune checkpoint inhibitor or  unresectable For treatment of that have progressed after treatment and for which there are no other treatment options High (MSI-H) or  (
Keytruda (pembrolizumab) Immune checkpoint inhibitor or  unresectable For the treatment of that have progressed after treatment and for which there are no other treatment options High (TMB-H)

paying-for-service paying-for-service

Paying for testing

Insurance companies are required to cover the costs for cancer treatment. However, health plans may vary on the amount of out-of-pocket costs and coverage for specific doctors, facilities or treatments. Your doctor's office and treating hospital should disclose how much your treatment may cost you and work with your insurance company to help you plan for the cost of your care. Visit our Health Insurance Appeals page for additional information on insurance appeals. 

Medicare will cover the cost for genetic testing and testing for people who meet certain criteria. Medicare coverage varies based on the policies of Medicare in your region. Visit this site to find and contact your regional Medicare provider for more information about coverage. The Medicaid website has a link to state Medicaid programs, which list specific eligibility for each state.

Some laboratories have assistance programs that help cover the cost for tumor testing: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.

updated: 01/22/2022

paying-for-service paying-for-service

Paying for cancer treatment

The majority of public and private health insurance plans are required to cover cancer diagnosis and treatment; copays, coinsurance and deductibles often apply. Patient costs and coverage for specific doctors, facilities or treatments may vary based on your health plan. Visit our section on Insurance and Paying for Care: Treatment  for more information, links to sample appeal letters and other resources. 

Some pharmaceutical companies have assistance programs that help cover the cost for their medications: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Needy Meds: Assistance programs to help patients with cost of medications and other healthcare.
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.

updated: 01/22/2022

clinical-trials clinical-trials

The following are studies looking at treatment for people with advanced

updated: 06/26/2022

clinical-trials clinical-trials

The following are studies looking at PARP inhibitors and similar agents for treating people with ovarian cancer.  

A number of other clinical trials for people with ovarian cancer can be found here.

updated: 03/13/2022

Last updated January 23, 2022