Maintenance Therapy After Ovarian Cancer Treatment

Maintenance therapy may be discussed after ovarian cancer responds to surgery and chemotherapy. The goal is to hold that response in place for longer. Biomarkers such as BRCA or HRD can affect the conversation.

Regimen names can look like alphabet soup. They usually combine drug initials, timing, and sometimes the order of treatment. So use a regimen page this way. First learn what the name means. Then ask how your team's version applies to you.

Two kinds of drugs come up most often. One is a PARP inhibitor, a pill that blocks a repair pathway cancer cells use. Olaparib, rucaparib, and niraparib are PARP inhibitors used this way. The other is bevacizumab, a targeted drug given by infusion.

It may come up after first-line treatment or after treatment for recurrence. The same regimen name can be used in different situations. Doses and schedules vary too. Do not use this page to calculate doses or change medicines. Do not use it to compare yourself with someone else's plan.

Before a regimen begins, the team may confirm several things. Those include pathology, stage, biomarkers, organ function, and blood counts. They also include infection risk, medicines, allergies, and fertility concerns. The team may decide whether a port or PICC line is useful. Some regimens also call for anti-nausea medicines, steroid instructions, hydration plans, heart tests, or neuropathy checks.

• What are the names of each drug in my regimen?
• How many cycles are planned, and what would change that plan?
• Which side effects are common, and which are urgent?
• Will I need growth-factor shots, transfusions, or infection precautions?
• How will we know whether it is working?
• What happens if side effects force a delay or dose change?

Ask about blood counts, fatigue, nausea, blood pressure, and how long treatment is planned. Maintenance drugs are taken for months, so side effects that seem small at first can add up. Your team will check blood counts on a schedule, because low red cells, white cells, or platelets are a known concern with these drugs.

Your care team can tell you which side effects matter most for your exact regimen, doses, and health history. Ask for the after-hours number before the first infusion. Ask for the fever rules too.

Sometimes regimen choices offer similar benefits but different tradeoffs. Ask what the alternatives are, and why this plan is preferred. Ask whether a clinical trial is relevant. Ask whether a second opinion should happen before treatment begins.

• Call 911 or go to an emergency department if you have chest pain, sudden shortness of breath, weakness or numbness on one side, or heavy bleeding that will not stop.
• Treat fever as an emergency while you are on treatment. A temperature of 100.4°F (38°C) or higher, or shaking chills, means calling the oncology line immediately and going to an emergency department if no one answers. PARP inhibitors lower white cells, and the CDC describes fever during cancer treatment as a medical emergency rather than something to report the next working day.
• Call your care team the same day if you have severe belly pain, repeated vomiting, or new bruising, nosebleeds, or blood in your urine or stool.
• Call your care team within a day or two if you have worsening tiredness or breathlessness with everyday activity, a home blood pressure reading much higher than usual, or nausea that keeps you from eating or drinking.

Do not stop or change a maintenance drug on your own. Call the team first, even if the plan turns out to be a pause.

Start with Chemotherapy, How Chemotherapy Is Given, What to Bring to Chemotherapy, and Low White Blood Cells During Chemotherapy.

• National Cancer Institute — Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ)
• National Cancer Institute — Infection and Neutropenia During Cancer Treatment
• National Cancer Institute — Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment