Understanding Chemotherapy for Ovarian Cancer

Chemotherapy (chemo) is most often used as a first-line treatment for ovarian cancer. It’s typically given before surgery to help shrink tumors, which makes them easier to remove.

Chemo is often continued after surgery in an effort to destroy cancerous cells that may be left behind after the tumors have been removed.

Chemo is part of the treatment plan for most stages of ovarian cancer.

Chemotherapy treatment for ovarian cancer usually involves getting a combination of two different drugs at the same time. According to the American Cancer Society, this seems to be more effective than just getting one type of chemo drug.

The combination of chemotherapy drugs for ovarian cancer typically includes a platinum-based compound (most often carboplatin) and a different type of chemo drug known as a taxane (typically paclitaxel). These drugs are usually given intravenously every 3–4 weeks.

Using different drugs together can help destroy cancer cells in different ways. For instance, the platinum-based chemo drugs work by binding to the DNA of cancer cells, which causes damage to the cell’s DNA, ultimately killing the cancer cell. The taxane drug works by preventing cancer cells from dividing and growing.

Another drug that’s commonly used alongside carboplatin and paclitaxel is bevacizumab (Avastin). Avastin isn’t a chemo drug. Instead, it works by blocking a protein called vascular endothelial growth factor (VEGF).

This protein is necessary to help cancer cells make new blood vessels. By blocking VEGF, Avastin cuts off the blood supply that cancer cells need to survive and grow.

The exact chemo drugs that are used may depend on many factors, including the type of ovarian cancer you have, the cancer stage, and other individual factors. Besides the drugs already mentioned, other chemo drugs that may be used include:

• altretamine (Hexalen)
• capecitabine (Xeloda)
• cisplatin
• cyclophosphamide (Cytoxan)
• docetaxel
• gemcitabine (Gemzar)
• ifosfamide (Ifex)
• liposomal doxorubicin (Doxil)
• melphalan
• pemetrexed (Alimta)
• topotecan
• vinorelbine (Navelbine)

The typical course of chemotherapy depends on a variety of factors and can vary from one person to the next. But there are some common treatment courses.

For instance, many people have chemo every 3 or 4 weeks for three treatment cycles before surgery. Often, chemotherapy drugs will be given for another three to six cycles after surgery.

This chemo cycle maximizes the effectiveness of the chemo drugs, but also allows your body to rest and recover in between treatments. Chemo for ovarian cancer is usually given through an intravenous (IV) line that goes into a vein, or by taking a capsule by mouth.

Sometimes, chemotherapy is also delivered through a catheter placed in your stomach. This is called intraperitoneal chemotherapy. It delivers a concentrated amount of chemotherapy drugs directly into your abdominal cavity.

Some research shows that people with ovarian cancer who have intraperitoneal chemotherapy may have a lower recurrence rate and better outcomes than people who only get chemo alone. But the side effects may be more severe.

Intraperitoneal chemotherapy is used less often than systemic chemo that’s administered through an IV line, but it can be an effective way to destroy ovarian cancer cells when it’s used in addition to regular chemotherapy treatment.

There are many different types of side effects linked to chemo drugs. Not everyone will experience every side effect. The most common side effects include:

• loss of appetite
• fatigue
• nausea
• vomiting
• hair loss
• skin rashes
• mouth sores
• increased risk of infections
• easy bruising and bleeding

These side effects are normally temporary. They’ll start to resolve once your chemo treatment has ended. Sometimes, long-term chemo side effects can occur. These are less common, but can include:

• nerve damage
• early menopause
• infertility
• kidney damage
• bone marrow damage
• bladder irritation

The survival rate of ovarian cancer after chemotherapy depends on multiple factors, such as:

• the cancer stage at diagnosis
• the type of ovarian cancer
• the success of tumor removal surgery

The 5-year survival rates for three types of ovarian cancer are outlined by stage in the chart below. These rates are based on data collected by the American Cancer Society between 2012 and 2018. Current survival rates might be higher.

Chemotherapy isn’t done alone. It’s part of an overall treatment plan for ovarian cancer. Other treatments that may be involved include:

• surgery to remove the cancerous tumor
• hormone therapy, which is most often used to treat ovarian stromal tumors
• targeted therapies that can help change the way some cancer cells grow, divide, or interact with other cells
• immunotherapy drugs that activate your immune system to detect and destroy cancer cells

Chemotherapy is a trusted and proven treatment for ovarian cancer. It’s used to destroy cancer cells before and after surgery and can be used for most stages of ovarian cancer.

Typically, chemo is given every 3 or 4 weeks for three treatment cycles before surgery. It’s often given for another three to six cycles after surgery. This can vary depending on the type of ovarian cancer you have, the cancer stage at the time of diagnosis, and the type of chemo drugs you’re given.

Chemotherapy isn’t used on its own. It’s part of an overall treatment plan that includes surgery to remove the tumor. Other therapies such as immunotherapy, hormone therapy, or targeted therapies may also be used.