Ovarian, Fallopian Tube, and Peritoneal Cancer: Treatment Options
"Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’
ability to grow and divide. Chemotherapy is given by a gynecological oncologist or a medical oncologist, a doctor who specializes in treating cancer with medication.
Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).
A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.
Most of the chemotherapy options described below apply to epithelial ovarian cancer, as well as fallopian tube cancer and peritoneal cancer. The type of the chemotherapy used depends on several factors.
- Adjuvant chemotherapy. This is done to destroy cancer
remaining after surgery. This treatment typically consists of
carboplatin (Paraplatin) given with paclitaxel (Taxol) or docetaxel
(Docefrez, Taxotere) intravenously (IV), which is through the vein. Most
of these drugs are given every 3 weeks.
Another approach is called “dose-dense” chemotherapy. This is when the drugs are giving weekly instead of every 3 weeks. Some studies show that using dose-dense paclitaxel with carboplatin may improve survival rates compared to giving the drugs every 3 weeks. Talk with your doctor about which scheduling option is best for your situation. (The recent ICON 8 study reported on at #ESMO17 found no difference in survival between dose dense and every 3 week chemotherapy http://www.esmo.org/Conferences/ESMO-2017-Congress/Press-Media/Press-Releases/ICON8-Trial-Reaffirms-Standard-Dosing-in-Ovarian-Cancer-Chemo)
In addition, a third way to give adjuvant chemotherapy is to infuse it directly into the abdomen. This is called intraperitoneal or “IP” chemotherapy. This approach can be considered for women with stage III disease after a successful surgical debulking procedure. In previous studies, IP treatment was more effective when compared to intravenous treatment on the every 3-week schedule.
Studies comparing dose-dense (weekly) IV chemotherapy with carboplatin and paclitaxel to IP chemotherapy with the same drugs show similar outcomes. Doctors are discussing whether the more intense IV approach can replace the use of IP chemotherapy.
With each of these approaches, doctors consider a variety of factors, such as age, kidney function, and other existing health problems.
Research studies are underway to see if additional medications, such as PARP inhibitors, should be used. Several studies have evaluated whether adding bevacizumab (Avastin), which is an anti-vascular or “blood vessel growth blocking” antibody, to standard chemotherapy following initial surgery is helpful. In general, bevacizumab used for ovarian cancer has prolonged the time in some patients before the cancer returns; see Latest Research."
Additional information on chemotherapy may be found on these pages:
https://www.nccn.org/patients/guidelines/ovarian/index.html
http://www.foundationforwomenscancer.org/types-of-gynecologic-cancers/ovarian/chemotherapy/
Dee
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