Targeted treatments for ovarian cancer

Find out more about access to the latest targeted treatments for ovarian cancer across the UK.

Some women with ovarian cancer may be offered targeted cancer treatments. Whether these treatments are suitable for you will depend on your individual circumstances, such as the type of cancer, whether surgery is possible and if your cancer responds well to chemotherapy.

The way drugs are approved for use in the NHS differs across the UK which means that there can be some differences in what drugs are available depending on where you live.

PARP inhibitors

What are PARP inhibitors?

PARP inhibitors are drugs that can be used to stop cancer cells repairing DNA damage within themselves, so the cancer cells die. You might hear PARP inhibitors called ‘targeted therapies’ or ‘maintenance treatments’ because they target cancer cells and help reduce the chance of the cancer coming back or delay it coming back.

PARP inhibitors start within 8–12 weeks after finishing chemotherapy. At the moment there are three PARP inhibitors available in the UK for ovarian cancer: niraparib (Zejula®), olaparib (Lynparza®), and rucaparib (Rubraca®). These are given as tablets.    

Which ones you're eligible for and at what stage of your treatment depends on your personal situation, whether you have a BRCA1 or 2 gene mutation or whether your tumour tests positive for homologous recombination deficiency (HRD).

Why do genetic mutations make a difference? 

Our genes help our cells (the building blocks that make up our body) to function normally. However, sometimes the genes have small changes, known as alterations or mutations. These mutations can stop a cell from repairing itself properly if it becomes damaged. This can sometimes result in an increased risk of developing cancer compared to people who don’t have the genetic change. Cancer cells are less likely to be able to repair themselves in people:

  • who carry the BRCA1 or BRCA2 gene mutations
  • whose tumour tests positive for HRD

Using PARP inhibitors can block this further so that cancer cells are less likely to repair themselves and grow.  

Speak to your oncologist about your options for being tested. 

Why haven’t I been offered a PARP inhibitor?

Not all drugs will be appropriate or effective for everyone. If you have questions about whether a drug might work for you, or about why you have – or haven’t – been offered one, speak to your clinical team.

Who can access PARP inhibitors?

At the moment PARP inhibitors are available to women who have advanced ovarian cancer (stage III or IV) and who are ‘platinum-sensitive’. You're platinum-sensitive if it's been six months or more since your last treatment with carboplatin or cisplatin chemotherapy.

Currently you can only change from taking one type of PARP inhibitor to another if you're having side effects and you're responding to the PARP inhibitor you're on at the moment. This is because each of the three PARP inhibitors works in a similar way, so if you don’t respond to one type it isn't likely you'll respond to another. This change has to be made within three months of starting the first PARP.

You can also only access PARP inhibitors once as if you don’t respond to them the first time you take them, it's unlikely you will respond to them in future.

Access in England, Northern Ireland and Wales

Olaparib

Women with a BRCA mutation can access olaparib as a maintenance treatment after their first-line (first course of) treatment onwards.

Women whose tumour tests positive for HRD can access olaparib with bevacizumab as a maintenance treatment from their first-line treatment onwards. 

Niraparib

Women with a BRCA mutation can access niraparib as a maintenance treatment after their first-line or second-line treatment only.

Women without a BRCA mutation can access niraparib as a maintenance treatment after their first-line treatment onwards. 

Rucaparib

Women with a BRCA mutation can access rucaparib as a maintenance treatment after their second-line treatment onwards. 

Women without a BRCA mutation can access rucaparib as a maintenance treatment after their second-line treatment onwards.

Access in Scotland

Olaparib

Women with a BRCA mutation can access olaparib as a maintenance treatment after their first-line (first course of) treatment onwards.

Niraparib

Women without a BRCA mutation can access niraparib as a maintenance treatment after their second-line treatment onwards.

Rucaparib

Women without a BRCA mutation can access rucaparib as a maintenance treatment after their second-line treatment onwards.

Bevacizumab

What is bevacizumab?

Bevacizumab (Avastin®) is a type of drug known as a ‘monoclonal antibody’ which targets a cancer cell protein called Vascular Endothelial Growth Factor (VEGF). This protein helps cancers to create blood vessels, which are needed to enable the cancer to grow. By specifically targeting this protein, bevacizumab stops these blood vessels from being created and starves the cancer of what it needs to survive and grow. You might also hear it called Avastin®. 

How is bevacizumab given?

Bevacizumab (Avastin®) is given through a drip into the vein at the same session as the chemotherapy drugs (platinum and paclitaxel). It also continues after chemotherapy has finished as a maintenance treatment (that aims to keep your ovarian cancer under control for as long as possible).

After chemotherapy has finished your oncologist will give you up to 12 more doses of bevacizumab with one dose (cycle) every three weeks. Ask your oncologist whether bevacizumab may be an option for you.

Access in England

Women in England may be able to access bevacizumab at their first-line (first course of) treatment if they have:

  • stage III ovarian cancer where the surgeon was unable to remove all of the cancer during their first surgery (suboptimally debulked), or
  • stage IV ovarian cancer

Women can access bevacizumab regardless of whether they have a BRCA mutation.

Women whose tumour tests positive for HRD can access olaparib with bevacizumab as a maintenance treatment from their first-line of treatment onwards. 

Access in Scotland

Women in Scotland may be able to access bevacizumab at their first-line (first course of) treatment if their ovarian cancer is stage IV. 

Women in Scotland may be able to access bevacizumab if their ovarian cancer returns (recurs) and is platinum-resistant (where platinum-based chemotherapy has stopped working).

Access in Wales and Northern Ireland

Currently bevacizumab is not available on its own to women in Wales and Northern Ireland. 

Women whose tumour tests positive for HRD can access olaparib with bevacizumab as a maintenance treatment from their first–line of treatment onwards. 

If you have any questions about any of these ovarian cancer drugs you can always call our support line on 020 7923 5475 (9am–5.30pm, Monday–Friday) and speak to one of our specialist nurses.