Some women with ovarian cancer may be offered targeted cancer treatments. Targeted therapies work on specific genes and proteins that are involved in the growth and survival of cancer cells.
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.
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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.
You can receive a PARP inhibitor if you have stage 3 or 4 high-grade epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer that has responded to platinum-based chemotherapy (usually carboplatin or cisplatin and paclitaxel).
You can 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.
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 variant or whether your tumour tests positive for homologous recombination deficiency (HRD).
Use our helpful tool below to find out which PARP inhibitors you may be able to access.
Why do genetic variants 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 genetic variants. These gene variants 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 variants
- 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.
Watch our session on genetics and targeted treatment, led by Dr Rowan Miller, Consultant Medical Oncologist.
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.
MEK inhibitors
What are MEK inhibitors?
MEK inhibitors work by targeting proteins (called MEK proteins) that help cancer cells to grow. By blocking these proteins the growth of the cancer cells will stop or slow down.
At the moment there is one MEK inhibitor available in the UK for ovarian cancer: trametinib (Mekinst®). This is given as tablets and may be accessed by those with advanced low grade serous ovarian cancer.
Who can access MEK inhibitors?
- Access in England
If you have advanced low grade serous ovarian cancer you may be able to access trametinib.
- Access in Northern Ireland, Wales and Scotland
Currently trametinib is not available to women in Northern Ireland, Wales and Scotland.
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.
Who can access bevacizumab?
- Access in England and Wales
You may be able to access bevacizumab at your first-line (first course of) treatment if you have:
- stage 3 ovarian cancer where the surgeon was unable to remove all of the cancer during their first surgery (suboptimally debulked), or
- stage 4 ovarian cancer
You can access bevacizumab regardless of whether you have a BRCA gene variant.
If your tumour tests positive for HRD you can access olaparib (a PARP inhibitor) with bevacizumab as a maintenance treatment from your first-line of treatment onwards.
- Access in Scotland
You may be able to access bevacizumab at your first-line (first course of) treatment if your ovarian cancer is stage 4.
You may be able to access bevacizumab if your ovarian cancer returns (recurs) and is platinum-resistant (where platinum-based chemotherapy has stopped working).
- Access in Northern Ireland
Currently bevacizumab is not available on its own to women in Northern Ireland.
If your tumour tests positive for HRD you can access olaparib with bevacizumab as a maintenance treatment from your first–line of treatment onwards.
