Treatment of Stage IV Ovarian Cancer

This content has been reviewed and approved by

Maurie Markman, MD
Vice President, Clinical Research
MD Anderson Cancer Center
University of Texas
 

Patients diagnosed with stage IV or metastatic ovarian cancer have disease that has spread outside the abdomen or into the liver.

A variety of factors will ultimately influence your decision to receive treatment for cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase your chance of cure, or prolong your survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of stage IV ovarian cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this website is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Currently, the standard treatment for stage IV ovarian cancer consists of both surgery and chemotherapy. Unfortunately, less than 10 percent of patients experience long-term, disease-free survival following standard treatment. This is because stage IV ovarian cancer is difficult to completely remove with surgery and the currently available chemotherapy is unable to eradicate all of the remaining cancer. Both optimal surgical debulking and platinum-based chemotherapy prolong the time to cancer recurrence and improve overall survival.

Surgical Debulking

During debulking surgery, physicians attempt to remove as much of the ovarian cancer as possible. Debulking is believed to be beneficial because it reduces the number of cancer cells that ultimately need to be destroyed by chemotherapy and therefore decreases the likelihood of the cancer developing a resistance to chemotherapy.

Following surgical debulking, all patients with stage IV ovarian cancer are offered additional treatment. In some situations, a decision is made to proceed with chemotherapy without an attempt to surgically remove the tumor volume.

Chemotherapy for Stage IV Ovarian Cancer

Regardless of the timing or the necessity of performing interval debulking surgery, combination chemotherapy using one or more anticancer drugs is considered "standard" treatment for patients with stage IV ovarian cancer.

Clinical trials have demonstrated that for patients with advanced stage ovarian cancer, treatment with combination chemotherapy regimens containing a platinum compound Platinol® (cisplatin) or Paraplatin® (carboplatin) prolongs the duration of survival and prevents more recurrences of cancer compared to treatment with surgery and nonplatinum compounds. Current adjuvant chemotherapy typically consists of Taxol® or OnxolTM (paclitaxel) or Taxotere® (docetaxel) and a platinum compound administered every 3 weeks for six cycles.

Unfortunately, fewer than 10 percent of patients treated with a platinum compound and paclitaxel survive without evidence of cancer recurrence 5 years following treatment. Because many patients still experience recurrence of their cancer following standard therapy, some patients and their doctors consider participation in clinical trials evaluating new treatment approaches such as the use of targeted therapies, like bevacizumab (Avastin®).

Clinical Trial Participation

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients.

Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. If you are interested in participating in a clinical trial, you should discuss the risks and benefits of clinical trials with your physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news to learn about new treatments and the results of clinical trials.

Before deciding to receive chemotherapy treatment or to participate in a clinical trial, you should ensure you understand the answer to three questions:

1. What is my prognosis (risk of cancer recurrence) without adjuvant chemotherapy treatment?
2.  How will my prognosis be improved with treatment?
3. What are the risks of treatment?

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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