Chemotherapy for ovarian cancer

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Most women with ovarian cancer have chemotherapy. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

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

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the ovary.

Chemotherapy for ovarian cancer may be given intravenously (into a vein) or by intraperitoneal (IP) chemotherapy. When drugs are given during IP chemotherapy, they circulate and treat tumours throughout the abdomen as well as being absorbed into the blood stream. So IP chemotherapy is also considered to be a type of systemic treatment.

IP chemotherapy is only given if the cancer has spread inside the abdomen and there is minimal cancer left after surgery. During IP chemotherapy, drugs are injected directly into the abdomen through a port. The port allows the drugs to be safely delivered. The surgeon may place the port at the time of surgery for the ovarian cancer or as a separate surgery.

If you have IP chemotherapy, you will also have intravenous chemotherapy so the side effects may be more severe than with just intravenous chemotherapy alone.

Chemotherapy for epithelial ovarian cancer is usually a combination of 2 or more drugs given every 3 to 4 weeks intravenously. Usually a platinum drug such as carboplatin or cisplatin is 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

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

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 comes back (recurs). The type of drugs used will depend on if the cancer is sensitive to a platinum drug or never completely goes away with 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 in less than 6 months after treatment was finished, other non-platinum drugs will be given. These drugs can include:

• docetaxel
• paclitaxel
• etoposide (Vepesid)
• gemcitabine
• cyclophosphamide (Procytox)
• irinotecan
• pemetrexed
• topotecan
• vinorelbine
• pegylated liposomal doxorubicin (Caelyx)

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

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

If an ovarian stromal tumour does not respond to chemotherapy or hormonal therapy drugs used in earlier treatments, or if it recurs, another combination of drugs may be used.

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 ovarian germ cell tumour does not respond to drugs used in earlier treatments or if it recurs, other drug combinations that may be used are:

• VeIP – vinblastine, ifosphamide (Ifex) and cisplatin
• TIP – paclitaxel, ifosphamide and cisplatin
• VIP – etoposide, ifosphamide and cisplatin

The most common chemotherapy drug combinations used to treat borderline tumours are carboplatin or cisplatin combined with another drug such as paclitaxel. Chemotherapy may be given after surgery for a tumour that has come back (recurred).

The most common chemotherapy drug combinations used to treat primary peritoneal carcinoma are the same as those used to treat epithelial ovarian cancer. Intraperitoneal chemotherapy may be given in addition to intravenous chemotherapy if there are still small tumours remaining after surgical debulking.

Side effects can happen with any type of treatment for ovarian cancer, but everyone’s experience is different. Some women have many side effects. Other women have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects will go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for ovarian cancer are:

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

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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

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