Chemotherapy for ovarian cancer

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy.

Chemotherapy is often used to treat ovarian cancer. It may also be used to treat fallopian tube and primary peritoneal cancer, which are very similar to ovarian cancer. These cancers start in the same type of tissue as most ovarian cancers and are staged and treated the same way. If you have chemotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

Chemotherapy may be the only treatment you have or it may be used along with other cancer treatments. You may have chemotherapy to:

• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• shrink a tumour before surgery (called neoadjuvant chemotherapy)
• relieve pain or control the symptoms of advanced cancer (called palliative chemotherapy)

Chemotherapy for ovarian, fallopian or primary peritoneal cancer can be given:

• into a vein ( intravenously or by IV)
• directly into the abdomen (intraperitoneal or IP chemotherapy)

Chemotherapy is usually given by IV. IP chemotherapy is given if surgery could not completely remove the tumour in the abdomen and the tumour is smaller than 1 cm. IP chemotherapy is given through a port-a-cath. The surgeon may place the port under your skin during surgery to treat the cancer or as a separate surgery. The port-a-cath delivers drugs directly into your abdomen.

When drugs are given through IP chemotherapy, they circulate and treat tumours throughout the abdomen and are absorbed into the bloodstream. So IP chemotherapy is also considered to be a systemic treatment.

When chemotherapy drugs are heated before putting them into the body, it is called hyperthermic intraperitoneal chemotherapy (HIPEC). This is a type of IP chemotherapy that may be given to destroy any cancer cells left behind after surgery. Once the surgeon has removed as much of the tumour as possible, a machine heats the chemotherapy and pumps it into the abdomen through a catheter. The surgeon may gently rock your body from side to side to move the chemotherapy around. After about 30 minutes to an hour, the chemotherapy is drained and the abdomen is then rinsed with a salt water (saline) solution.

HIPEC may not be offered in all treatment centres. If you are having HIPEC, your healthcare team will tell you to expect with this treatment.

Chemotherapy for epithelial ovarian cancer is most often given as a combination of 2 or more drugs. A platinum drug such as carboplatin or cisplatin is usually combined with a taxane drug such as paclitaxel or docetaxel.

The most common chemotherapy drug combinations are:

• carboplatin and paclitaxel
• carboplatin and docetaxel
• cisplatin and paclitaxel

These drugs will be given every 3 to 4 weeks by IV.

You may be offered IP chemotherapy if you have stage 3 cancer with tumours smaller than 1 cm in size after primary surgical debulking. Cisplatin and paclitaxel are most often used in IP chemotherapy.

Different drugs may be given if epithelial ovarian cancer does not respond to a platinum drug combined with a taxane drug. Chemotherapy is also given if epithelial ovarian cancer recurs. The type of drugs used will depend on if the cancer is has previously responded to a platinum drug or didn’t completely go away after the first chemotherapy.

If the cancer responded to a platinum drug the first time and the cancer comes back more than 6 months after the last chemotherapy treatment, treatment is most likely a platinum drug combination.

If the cancer didn’t completely go away with the first chemotherapy or came back less than 6 months after treatment was finished, other non-platinum drugs will be given. These drugs can include:

• docetaxel
• paclitaxel
• etoposide
• gemcitabine
• cyclophosphamide
• irinotecan
• pemetrexed
• topotecan
• vinorelbine
• pegylated liposomal doxorubicin

The most common chemotherapy drug combinations used to treat fallopian tube cancer and primary peritoneal cancer are the same as those used to treat epithelial ovarian cancer. IP chemotherapy may be given in addition to IV chemotherapy if there are still small tumours left behind in the abdomen after surgical debulking (surgery to remove as much of the cancer as possible).

Cisplatin, etoposide and bleomycin (BEP) is the most common chemotherapy drug combination used to treat stromal cell ovarian cancer.

If the cancer doesn't respond to chemotherapy used in earlier treatments, or if it recurs, another combination of drugs may be used. Other chemotherapy drug combinations that may be used to treat stromal cell ovarian cancer are:

• carboplatin and paclitaxel
• EP – etoposide and cisplatin
• CAP – cyclophosphamide, doxorubicin and cisplatin

The most common chemotherapy drug combinations used to treat germ cell ovarian cancer are:

• PEB (or BEP) – cisplatin, etoposide and bleomycin
• carboplatin and etoposide

If the cancer doesn't respond to drugs used in earlier treatments, or if it recurs, other drug combinations that may be used are:

• VeIP – vinblastine, ifosfamide and cisplatin
• TIP – paclitaxel, ifosfamide and cisplatin
• VIP – etoposide, ifosfamide and cisplatin
• VAC – vincristine, dactinomycin and cyclophosphamide

Side effects of chemotherapy will depend mainly on the drug, the dose, how it's given and your overall health. If you have both IP chemotherapy and IV chemotherapy, you may have more severe side effects than with just IV chemotherapy alone. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Common side effects of chemotherapy drugs used for ovarian, fallopian tube or primary peritoneal cancer include:

• nausea and vomiting
• loss of appetite
• sore mouth and throat
• low blood cell counts
• infection
• hair loss
• fatigue
• treatment-induced menopause
• fertility problems
• peripheral neuropathy
• skin problems

Find out more about chemotherapy and the side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.