TARGETED THERAPIES FOR OVARIAN CANCER

Cancer occurs when genetic mutations in our cells cause them to multiply uncontrollably and accumulate to form a tumour.

Targeted cancer therapies are drugs that stop the spread of cancer by identifying and blocking the genetic changes responsible for the cancer’s growth and progression. 

There are different targeted therapies available to women with ovarian cancer. Find out whether you’re eligible and how to access these treatments. 

Ovarian cancer drug: Avastin

Avastin (the brand name of the drug Bevacizumab) belongs to a group of treatments called anti-angiogenics. These treatments stop cancer from developing new blood vessels. This restricts the supply of food and oxygen to the cancer, which means it is starved and unable to grow. 

In England, Avastin is used to treat first-line ovarian cancer following the standard treatment combination of Carboplatin and Paxitaxol. It is available through the Cancer Drugs Fund (CDF) only to patients with advanced ovarian cancer as a maintenance drug, which means it aims to prevent or delay the cancer’s return. 

In Scotland, Avastin is available for women with recurrent, platinum resistant ovarian cancer.

You can read about the different side-effects of Avastin here. 

PARP inhibitors

PARP inhibitors are a new class of targeted cancer drug that is becoming more common in ovarian cancer treatment. 

They can prevent the spread of cancer by stopping a protein called PARP from performing its usual job of helping damaged cells repair themselves. PARP inhibiters can stop (‘inhibit’) this repair process from happening in damaged ovarian cancer cells, which causes the cancer cells to weaken and die.  

There are currently three PARP inhibitors available to treat ovarian cancer: olaparib, niraparib and rucaparib.

Ovarian cancer drug: Olaparib

Olaparib (Lynparza®) is a maintenance drug that’s used to treat advanced high grade epithelial ovarian, fallopian tube, or primary peritoneal cancer in women with a BRCA1 or BRCA2 gene mutation following chemotherapy treatment. 

Olaparib doesn’t cure ovarian cancer but it can prevent its progression. By potentially delaying the spread of the disease, women can feel better and live healthier lives for longer. The increase in time between rounds of chemotherapy, combined with the fact olaparib can be taken in tablet form at home, means fewer trips to the hospital to receive treatment. 

To be eligible, a patient’s tumour must be ‘platinum sensitive’ – meaning it still responds to platinum-based chemotherapy. 

Olaparib is available on the NHS in England, Wales, Scotland and Northern Ireland in the form of tablets (two tablets, twice daily). 

Patients in England, Wales and Northern Ireland who are already taking olaparib capsules (eight capsules, twice daily) will be transitioned on to tablets in due course.  

For Scotland, plans to transition patients who are taking olaparib capsules to tablets are under discussion with the Scottish Medicines Consortium and the outcome is to be confirmed.

If you have been diagnosed with ovarian cancer and are unsure whether or not you carry a BRCA gene mutation, ask your cancer team about BRCA and genetic testing. You can also find lots of helpful information and guidance on our BRCA Hub. 

Cancer Research UK provides a useful overview of olaparib which you can read here. 

Ovarian cancer drug: Niraparib

Niraparib (also known as Zejula) is a maintenance treatment for ovarian cancer. This means it doesn’t cure ovarian cancer but it does prevent its progression. By delaying the spread of the disease, Niraparib can help women feel better and live healthier lives for longer, experiencing reduced symptoms.

Niraparib can be accessed by women across the UK to treat some types of ovarian cancer.

It’s available to women with recurrent platinum-sensitive high grade serous epithelial ovarian cancer, fallopian tube or primary peritoneal cancer following response to chemotherapy. This means it can be given to women if their ovarian cancer has come back (recurred) after they respond to a round of chemotherapy. Niraparib can be given to women whether or not they carry a BRCA gene mutation - except in Scotland, where it’s only available to patients without a BRCA mutation.

Niraparib is now also available to newly diagnosed ovarian cancer patients in England. The National Institute for Health and Care Excellence (NICE) have said Niraparib can treat women with advanced high grade serous epithelial ovarian cancer, fallopian tube or primary peritoneal cancer from their first round of treatment, after response to chemotherapy, regardless of genetic status.  

Wales and Northern Ireland are expected to follow suit and make Niraparib available as a first-line treatment immediately. Scotland will make a decision later in the year.   

Read more about its approval as a first-line treatment in England here.

Read more about its approval for NHS use and in Northern Ireland here.

Ovarian cancer drug: Rucaparib

Rucaparib (also known as Rubraca) is a new maintenance treatment available to women with relapsed ovarian, fallopian tube or peritoneal cancer, if their cancer has already responded to platinum-based chemotherapy. It is available to patients in England whether or not they carry a BRCA1/2 gene mutation. It is available on the NHS in Scotland only to women who do not have a BRCA gene mutation. 

It is a twice-daily tablet which helps slow down the progression of cancer and delays the need for further chemotherapy.

Rucaparib was approved by the National Institute for Health Excellence (NICE) through the Cancer Drugs Fund, and by the Scottish Medicine Consortium (SMC). Wales and Northern Ireland are expected to follow suit shortly. 

Ovarian cancer treatment combination: Olaparib and Avastin

An new and effective treatment combination is available to women with HRD positive advanced ovarian cancer in England and Scotland. 

A combination of Avastin and olaparib can be given to women with advanced (stage 3 or 4) high-grade epithelial ovarian fallopian tube or primary peritoneal cancer, who have experienced a complete or partial response after first-line platinum-based chemotherapy and Avastin. Their cancer must also be linked to HRD, which includes BRCA1/2 gene mutations.

Read more about this treatment combination here.

What is HRD?

HRD stands for homologous repair deficiency. This is what we call it when there is an error in one of the genes involved in repairing DNA. You may have heard of faulty BRCA1 or BRCA2 genes. They are just two of the genes involved in this DNA repair function, but there are many more.

Alterations in these genes can result in a higher risk of high-grade serous ovarian cancer, but also a better response to maintenance treatments, also known as PARP inhibitors. This treatment combination offers a new option for people who do not carry a BRCA mutation but are HRD positive. 

HRD testing is performed on a sample of a tumour after surgery, at the same time and in a similar way to how tumour BRCA testing works currently. All women with non-mucinous high grade serous ovarian cancer should now be considered for HRD testing. 

If you have just been diagnosed with high-grade serous ovarian cancer, you should ask your oncologist about HRD testing as part of your treatment pathway as it is in place from today. If you have previously been tested and found to not carry a faulty BRCA gene, then you can be retested for HRD. If you have a confirmed faulty BRCA gene (either through blood or tumour testing), you are classed as HRD positive so need no further testing to establish if you qualify for this treatment combination.