Ovarian Cancer - Medications

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Chemotherapy Drugs Studied for Relapsed or Refractory Cancer. Unfortunately, some ovarian tumors are resistant to platinum drugs. Even in patients who respond, the disease eventually becomes resistant to the first-line drugs, and the cancer returns. Various approaches for increasing responsiveness to these drugs are being investigated. Investigators are studying two approaches for preventing relapse after remission:

Developing more effective drug combination regimens to increase initial response rates and duration of the response.

Developing maintenance drugs to prevent or delay relapse.

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

Nucleoside analogs, including gemcitabine (Gemzar). In 2006, gemcitabine was approved as a treatment for recurrent ovarian cancer. It is used in combination with carboplatin for women with advanced ovarian cancer that has relapsed at least 6 months after initial therapy.

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) is a form of doxorubicin that remains in the bloodstream longer, tends to spare the bone marrow, and moves selectively through the tumor. It is showing promise in clinical trials and also may have fewer toxic effects than standard doxorubicin and other drugs 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 drugs, such as topotecan, carboplatin, and taxol.

Topoisomerase I inhibitors, including topotecan (Hycamtin) and irinotecan (Campto).

Topoisomerase II alpha inhibitors, including etoposide (VePesid).

Alkaloids, including vinorelbine (Navelbine).

Hormonal drugs: tamoxifen (Nolvadex) or anastrozole (Arimidex).

Other drugs. Valspodar and capecitabine (Xeloda) are oral drugs that may help improve response to other drugs, although data are preliminary.