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40

NCCN Guidelines for Patients

®

:

Ovarian Cancer, Version 1.2017

4

Cancer treatments

Hormone therapy

The

BRCA1

and

BRCA2

genes also help repair

DNA damage in cells. But, mutations in these genes

prevent them from making needed repairs. When

cancer cells have mutations in the

BRCA

genes,

they now must rely on PARP to repair DNA. These

drugs block the action of PARP so that the PARP

can no longer repair DNA damage in any cells. This

now makes it very hard for cancer cells with

BRCA

mutations to repair damaged DNA. If a cell is not

able to repair damaged DNA, it will die.

While all three drugs work the same, each of

these agents have been approved for certain use

to treat ovarian cancer. Typically patients need to

have a

BRCA1

or

BRCA2

germline mutation. For

example, olaparib is used in patients with

BRCA

mutations who have progressed after three lines

of prior chemotherapy treatment. Rucaparib is

given to those who have recurrent disease that

is platinum sensitive. Platinum sensitive means

the cancer initially responded to a platinum-based

chemotherapy but the cancer came back (recurred)

more than 6 months after treatment. Niraparib is

used in the recurrent setting but as maintenance

therapy (to help maintain a good response) after a

platinum-based chemotherapy.

Some common side effects of olaparib, rucaparib,

and niraparib are nausea, vomiting, diarrhea,

stomach pain, muscle or joint pain, feeling tired or

weak, not feeling hungry, and low blood cell counts.

Pazopanib

Pazopanib is a type of targeted therapy called a

TKI (

t

yrosine

k

inase

i

nhibitor). Tyrosine kinases

are proteins in cells that are important for many cell

functions. This includes sending signals in cells for

cell growth, survival, and death.

Some tyrosine kinases send signals that tell cancer

cells to grow and divide to make new cells.

Some send signals for new blood vessels to grow

into the tumor so it can survive. Pazopanib targets

several tyrosine kinases and blocks the signals that

help cancer grow and spread. Blocking these signals

may slow cancer growth.

Common side effects of pazopanib include diarrhea,

high blood pressure, and change in hair color,

nausea, vomiting, fatigue, and not feeling hungry.

Hormone therapy

Hormone therapy is treatment that stops the body

from making certain hormones or stops the action of

the hormones. Hormone therapy is not used as initial

treatment for ovarian cancer. But, it may be used

for ovarian cancer that has come back after other

treatments.

Estrogen and progesterone are hormones that help

some ovarian cancers grow. Estrogen is mostly made

by the ovaries and is made in small amounts by the

adrenal glands, liver, and body fat. Progesterone

is also mostly made by the ovaries. Blocking these

hormones from working or lowering hormone levels

may help slow ovarian cancer growth.

Different types of hormone therapy drugs work in

different ways. The hormone therapy drugs that may

be used for ovarian cancer include:

†

†

Tamoxifen – This drug stops the effect of

estrogen on cancer cell growth. It is in a class

of drugs called antiestrogens.

†

†

Anastrozole, exemestane, and letrozole –

These drugs lower estrogen levels in the body.

They are in a class of drugs called aromatase

inhibitors.