Ovarian Cancer - Medications

Once cancer recurs or continues to progress, a number of second-line chemotherapies are available or under investigation. The following lists some of agents that are being used, usually as single drugs, for relapsed or refractory cancers:

Paclitaxel or carboplatin alone or in combination. A landmark study published in the July 2003 Journal of Clinical Oncology, found that extended use of paclitaxel significantly delayed disease progression in women with advanced ovarian cancer.
Pegylated liposomal doxorubicin (Doxil, Myocet, Caelyx in Canada) is a liposome-encapsulated form of doxorubicin that remains in the blood stream longer, tends to spare the bone marrow, and move selectively through the tumor. It is showing promise in clinical trials and also may have fewer toxic effects than standard doxorubicin and other agents used for ovarian cancer. Studies show that Doxil is very well tolerated with a total response rate of about 20-30% in patients with recurrent cancer. This compares favorably with other agents such as Topotecan, Carboplatin, and Taxol.
Topoisomerase I inhibitors, including topotecan (Hycamtin) and irinotecan (Campto).
Nucleoside analogs, including gemcitabine (Gemzar).
Topoisomerase II alpha inhibitors, including etoposide (Vepesid).
Alkaloids, including vinorelbine (Navelbine)
Hormonal agents: tamoxifen (Nolvadex) or anastrozole (Arimidex).
Other agents. Valspodar and capecitabine (Xeloda) are oral agents that may help improve response to other drugs, although data are preliminary.

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Administration of Chemotherapy

In addition to studying individual drugs in different combinations, investigators are looking for the optimal sequence, dosages and timing of administering them. In general, the typical regimen is as follows:

Paclitaxel and carboplatin are administered in an outpatient clinic within several weeks of the surgery.
Each treatment takes about four to five hours to complete.
It is repeated every three weeks for a total of six times. (Each three-week interval is known as a cycle of chemotherapy.)

Such chemotherapy is usually administered intravenously (by vein).

Side Effects of Chemotherapy

Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment. Some may be long-lasting. In a 2002 study of ovarian cancer survivors, 20% reported that they had long-term treatment side effects, such as gynecologic and abdominal problems. Even so, most enjoyed a high quality of life that was comparable to other cancer survivors and peers without a history of cancer.