Targeted Therapy for Ovarian Cancer

Targeted therapy is a type of cancer treatment that uses drugs to identify and attack cancer cells while doing little damage to normal cells. These therapies attack the cancer cells' inner workings − the programming that makes them different from normal, healthy cells. Each type of targeted therapy works differently, but they all change the way a cancer cell grows, divides, repairs itself, or interacts with other cells.

Bevacizumab

Bevacizumab (Avastin) belongs to a class of drugs called angiogenesis inhibitors. For cancers to grow and spread, they need to make new blood vessels to nourish themselves (called angiogenesis). This drug attaches to a protein called VEGF (that signals new blood vessels to form) and slows or stops cancer growth.

Bevacizumab has been shown to shrink or slow the growth of advanced epithelial ovarian cancers. Bevacizumab appears to work even better when given along with chemotherapy having shown good results in terms of shrinking (or stopping the growth of) tumors. But it doesn’t seem to help women live longer.

Bevacizumab can also be given with olaparib (see below) as maintenance treatment in women whose cancers have the BRCA mutation or genomic instability (see below) and have shrunk quite a bit with chemotherapy containing carboplatin or cisplatin.

This drug is given as an infusion into the vein (IV) every 2 to 3 weeks.

Side effects of bevacizumab

Common side effects include high blood pressure, tiredness, bleeding, low white blood cell counts, headaches, mouth sores, loss of appetite, and diarrhea. Rare but possibly serious side effects include blood clots, severe bleeding, slow wound healing, holes forming in the colon (called perforations), and the formation of abnormal connections between the bowel and the skin or bladder (fistulas). If a perforation or fistula occurs it can lead to severe infection and may require surgery to correct.

PARP inhibitors

Olaparib (Lynparza), rucaparib (Rubraca), and niraparib (Zejula) are drugs known as a PARP (poly(ADP)-ribose polymerase) inhibitors. PARP enzymes are normally involved in one pathway to help repair damaged DNA inside cells. The BRCA genes (BRCA1 and BRCA2) are also normally involved in a different pathway of DNA repair, and mutations in those genes can block that pathway. By blocking the PARP pathway, these drugs make it very hard for tumor cells with an abnormal BRCA gene to repair damaged DNA, which often leads to the death of these cells.If you are not known to have a BRCA mutation, your doctor might test your blood or saliva and your tumor to be sure you have one before starting treatment with one of these drugs.

All of these drugs are taken daily by mouth, as pills or capsules.

Olaparib (Lynparza) and rucaparib (Rubraca) are used to treat advanced ovarian cancer, typically after chemotherapy has been tried. These drugs can be used in patients with or without mutations in one of the BRCA genes.

In women with a BRCA mutation:

  • Olaparib can be used to treat advanced ovarian cancer that has gotten smaller in response to first treatment with chemotherapy containing cisplatin or carboplatin.
  • Olaparib and rucaparib can be used to treat advanced ovarian cancer that has previously been treated with 2 or 3 chemotherapy drugs.  
  • Olaparib can be used with bevacizumab (see above) as maintenance treatment in women whose cancers have shrunk quite a bit with chemotherapy containing carboplatin or cisplatin.

In women without a BRCA mutation:

  • If the tumor has a high genomic instability score (a test measuring the amount of abnormal genes in cancer cells), olaparib can be used with bevacizumab as maintenance treatment in women whose cancers have shrunk quite a bit with chemotherapy containing carboplatin or cisplatin.

In women with or without a BRCA mutation:

  • Olaparib and rucaparib can be used to treat advanced ovarian cancer that has come back after treatment, and then shrank in response to chemotherapy containing cisplatin or carboplatin.

Olaparib and rucaparib can help extend the time before the cancer comes back or starts growing again.

These drugs have been shown to help shrink or slow the growth of some advanced ovarian cancers for a time. So far, though, it's not clear if they can help women live longer.

Niraparib (Zejula) may be used in different situations to treat ovarian cancer.

In women with or without a BRCA gene mutation:

  • Niraparib might be used as maintenance treatment for ovarian cancer, where the cancer has shrunk with chemotherapy containing cisplatin or carboplatin

In women with a BRCA mutation:

  • Niraparib might be used to treat advanced ovarian cancer after several chemotherapy drugs have been tried

In women without a BRCA mutation but whose tumor has a high genomic instability score (a test measuring the amount of abnormal genes in cancer cells):

  • Niraparib might be used to treat advanced ovarian cancer after several chemotherapy drugs have been tried and if the cancer started growing 6 months or more after the last chemo was given

These drugs have been shown to help shrink or slow the growth of some advanced ovarian cancers for a time. So far, though, it's not clear if they can help women live longer.

Side effects of PARP inhibitors

Side effects of these drugs can include nausea, vomiting, diarrhea, fatigue, loss of appetite, taste changes, low red blood cell counts (anemia), belly pain, and muscle and joint pain. Rarely, some patients treated with these drugs have developed a blood cancer, such as myelodysplastic syndrome or acute myeloid leukemia

Drugs that target cells with NTRK gene changes

A very small number of ovarian cancers have changes in one of the NTRK genes. Cells with these gene changes can lead to abnormal cell growth and cancer. Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are targeted drugs that stop the proteins made by the abnormal NTRK genes. These drugs can be used in people with advanced ovarian cancer whose tumor has an NTRK gene change and is still growing despite other treatments.

These drugs are taken as pills, once or twice a day.

Side effects of drugs that target NTRK gene changes

Common side effects include dizziness, fatigue, nausea, vomiting, constipation, weight gain, and diarrhea.

Less common but serious side effects can include abnormal liver tests, heart problems, and confusion.

More information about targeted therapy

To learn more about how targeted drugs are used to treat cancer, see Targeted Cancer Therapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Revised: June 10, 2020

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