After primary treatment for ovarian cancer, which typically includes surgery and chemotherapy, doctors may recommend starting maintenance treatment. There are two main reasons to begin maintenance treatment. For people who are in remission from ovarian cancer, maintenance therapy may help prevent or delay the cancer’s return. Alternately, maintenance treatment may help shrink tumors in advanced ovarian cancer or stop the cancer from getting worse.
Ovarian cancer maintenance treatment may include the same chemotherapy drugs a person received during their initial treatment, or it may involve starting new medications.
The U.S. Food and Drug Administration (FDA) has approved drugs from two different classes as maintenance therapies for ovarian cancer: angiogenesis inhibitors and poly (ADP-ribose) polymerase inhibitors — commonly called PARP inhibitors. People who have undergone ovarian cancer treatment may be prescribed drugs from one or both of these categories. Clinical trials are also underway to find new types of maintenance treatments.
Drugs in this class prevent tumors from using the body’s blood supply for fuel and growth. One example used for ovarian cancer is Avastin (Bevacizumab).
Angiogenesis inhibitors are given as an IV infusion at a doctor’s office, clinic, or hospital. Receiving IV therapy may be difficult for people who have mobility issues, don’t live close to a treatment center, or have busy schedules due to work or child care responsibilities. People undergoing maintenance therapy with angiogenesis inhibitors will likely receive an infusion every two to three weeks.
Poly (ADP-ribose) polymerase inhibitors make it harder for cells to repair damage, and can lead to higher levels of cancer cell death. Drugs in this category that may be prescribed for ovarian cancer include Zejula (Niraparib), Lynparza (Olaparib), and Rubraca (Rucaparib).
PARP inhibitors come in the form of pills or capsules. People who are prescribed these drugs typically take them once a day by mouth. The advantage of oral medication is that people can take this therapy at home. A potential disadvantage is the need to take responsibility for remembering to stick to the dosage schedule.
Read more about how maintenance treatments for ovarian cancer work.
Sticking to a medication schedule is important to make sure the treatments work as effectively as possible. If you miss doses, there may be negative effects.
It’s crucial to take maintenance treatment at the right times, exactly as directed, and using the correct dose.
Unfortunately, sticking to a cancer treatment plan may be difficult for many reasons. A person may experience side effects, have a hard time understanding the medication instructions, be distracted by life activities or events, forget doses, or have a hard time affording the cost of medication. Fortunately, there are many ways to minimize these barriers.
If your maintenance medication is taken by IV infusion, the biggest challenge with sticking to treatment may be making sure you are able to travel to your appointments. To make the process easier, put all treatment appointments on your calendar as soon as you book them. Make a transportation plan in advance. If transportation to infusion appointments is a challenge for you, here are some resources to consider:
Share your transportation concerns with your health care team, as they may be able to recommend other resources to make getting to and from appointments easier.
If your doctor prescribes an oral maintenance medication that is taken at home, there are several strategies you can use to stay on track with your treatment plan.
Get in the habit of taking your medication at the same time each day. Set an alarm on your clock or phone to help you remember, or take medication directly before or after completing another activity — such as brushing your teeth or eating a meal.
Use a calendar, daily planner, or smartphone app to keep track of all of your drugs. Mark off each dose as you take it. You may prefer a paper-based system or a downloadable app. Either way, choose a method that lists the medication name, dose, the time of day it should be taken, and any other instructions for using it.
Use an automatic pill dispenser or a pillbox with dividers to make it clear which medications need to be taken on which days. Refill the container at the same time every week.
Bring extra medication with you when you travel to ensure you don’t run out. Store it in your carry-on bag to make sure it’s not lost or damaged during air travel.
If you’re keeping cancer treatments around the house, it’s also important to make sure they are stored and handled safely. Keep medications away from children and pets, and store them separately from foods or medicine used by other family members. Wash your hands before and after you touch the medication. If another person, such as a caregiver, is handling medication, they should wear gloves so they don’t absorb the drug.
Your doctor will likely schedule regular follow-up visits while you are on maintenance therapy. Often, once people with ovarian cancer are done with primary treatment, they will have exams every two to four months. After a couple of years, these visits may decrease to every three to six months. At these visits, your doctor will most likely give you both a physical exam and a pelvic exam. Your oncologist may also order imaging scans to look for tumors or blood tests to identify tumor markers.
During this time, it’s also important to have regular check-ups with your primary care provider to monitor other aspects of your health and be screened for other types of cancer.
Different classes of maintenance treatments can cause different side effects. Side effects of angiogenesis inhibitors can include high blood pressure, bleeding, headaches, fatigue, low numbers of white blood cells, sores in the mouth, appetite loss, and diarrhea. Common side effects of PARP inhibitors include nausea, vomiting, diarrhea, stomach pain, appetite problems, changes in the way things taste, anemia (low red blood cell counts), tiredness, and muscle or joint pain.
If side effects bother you, talk to your cancer care team. They can help you find ways to better manage symptoms. If side effects are intolerable, your doctor may recommend switching to a maintenance treatment option that is easier for you to take.
Read more about living well with ovarian cancer.
Side effects can sometimes be managed to improve quality of life. The tips below include ways to manage common side effects.
Eat smaller meals more often. Additionally, avoid spicy, fried, very sweet, or high-fat foods. Your doctor may also prescribe anti-nausea medication to take before eating.
Make sure to drink a lot of fluids between meals to stay hydrated. Antidiarrheal medications may lessen this symptom.
Experiment with different foods to see what works for you. Some people find colder foods or foods with stronger seasonings are easier to eat. Eating sour or tart foods may also help lessen a metallic taste in your mouth.
Getting more physical activity can lessen tiredness. Make sure you’re getting all the nutrition you need. Therapy or counseling can also have a positive impact on fatigue. Finally, your doctor may be able to prescribe drugs that promote wakefulness.
Several mouthwash-based treatment options can lessen pain in your mouth. Other strategies include gargling with saltwater and baking soda, eating foods that don’t involve much chewing, and avoiding spicy, acidic, or coarse foods.
If you are receiving maintenance treatment, you’ll be dealing with medication for the long term. When you join MyOvarianCancerTeam, you gain a social support network of others who have been in your shoes. Share your own tips in a comment below or ask a question about maintenance treatment on MyOvarianCancerTeam.