Treatment for fallopian tube, ovarian and primary peritoneal cancer

Doctors base ovarian cancer treatment recommendations on several factors, including:

• Stage and grade
• Subtype
• Response of cancer to platinum chemotherapy (known as platinum sensitivity)
• Additional testing, including biomarkers and genetic testing for an inherited mutation

Treatment for fallopian tube, ovarian and primary peritoneal cancer usually involves a combination of surgery and systemic therapy. 

• Surgery for ovarian cancer consists of complete removal of the cancer, known as optimal debulking, whenever possible. Surgery also helps your doctor learn if the cancer has spread. Surgery before chemotherapy is used for patients who are healthy enough to endure an abdominal surgery with a 2-3 day hospital stay, and who have tumors that can be completely removed. In some cases, chemotherapy is given before surgery to help make the tumor smaller to remove as much of the tumor as possible. This is known as neo-adjuvant chemotherapy. 
• Systemic therapy treats the entire body in order to prevent or control spread to other areas. Systemic therapies include:
  • Chemotherapy
  • Targeted therapy (e.g., Avastin) 
  • PARP inhibitors
  • Immunotherapy
  • Hormonal therapy (used for ovarian stromal cell tumors)

Women in their childbearing years who wish to spare their fertility should speak to a specialist before surgery or other treatment.

Chemotherapy

• Treatment for ovarian cancer usually includes a type of agent known as platinum chemotherapy. Two common examples are carboplatin and cisplatin.
• A second type of chemotherapy, called a taxane, is usually combined with the platinum drug. Two common taxanes are paclitaxel and docetaxel.

Chemotherapy may be given in two different ways.

• Intravenous (IV) chemotherapy is injected into a vein. 
• Intraperitoneal (IP) chemotherapy is injected through a tube into the abdomen. Intraperitoneal therapy comes with additional side effects, and requires additional surgery to remove the port when chemotherapy is completed. 

Platinum-sensitive vs. platinum-resistant

• Platinum resistant cancers are those that do not shrink during platinum chemotherapy, or those cancers that initially respond, but come back within 6 months of treatment. 
• Platinum sensitive cancers respond to platinum treatment and do not recur for at least six months or longer.   

Timing of treatment

• Neoadjuvant chemotherapy is given before surgery to some women with advanced cancer. The goal is to shrink the tumors to help the surgeon remove as much of the cancer as possible. 
• After surgery, most women with high-grade and/or advanced ovarian cancer will receive chemotherapy. The goal of chemotherapy after surgery is to prevent recurrence or to control the growth and spread of the cancer. Some women with advanced ovarian cancer will also receive immunotherapy or targeted therapy as part of their post-surgery treatment. 
• Women whose ovarian cancer has recurred may receive additional chemotherapy, targeted therapy or immunotherapy after recurrence, depending on response to initial treatment and tumor biomarker testing.
• Maintenance therapy is given to some women after they complete chemotherapy treatment to keep the cancer from coming back or growing. You can read more on maintenance therapy.