Relapse and second line treatment

Although ovarian cancer is frequently controlled with chemotherapy (that is, put into remission), and you feel fit and well, the disease often returns. This is known as relapse, or recurrence of the cancer. It is difficult to predict how long the benefits of your treatment will last, as it varies in each individual case. Some treatments may work for only a few months, while other women have such a good response to chemotherapy that they remain in remission for five years and beyond - and they are cured.

If your ovarian cancer returns after initial ("first-line") chemotherapy, it is often appropriate to use more (and different) "second-line" drugs to achieve another remission. Some women may go on to receive third-line or even fourth-line chemotherapy to control the cancer.

The National Institute for Health and Clinical Excellence (NICE) recommends that you are offered one of four types of treatment depending on your circumstances.

You should be given time to discuss your treatment option with your healthcare team, members of your family and others, such as your GP if you wish.

What NICE recommends

NICE (National Institute for Health and Clinical Excellence) advises the NHS. It produces guidance on the use of medicines and when they should be used. It was set up to make sure you receive consistently high quality treatment, wherever you live. NICE guidance is relevant to England and Wales. In Scotland, the Scottish Intercollegiate Guidelines Network produces guidance. Northern Ireland does not have a similar organisation.

NICE guidance for the treatment of relapsed advanced ovarian cancer depends on:

how successful the first treatment was; and
how long it has been since the first course of chemotherapy.

Circumstances can be grouped into four scenarios:

Platinum refractory ovarian cancer; this is cancer that has not responded to first-line platinum based chemotherapy such as carboplatin or cisplatin.
Platinum resistant ovarian cancer; this is cancer that returns within six months of finishing first-line platinum based chemotherapy.
Platinum sensitive ovarian cancer; this is cancer that has responded to first-line platinum based chemotherapy but has returned 12 months or morafter finishing first-line treatment.
Partially platinum sensitive ovarian cancer; this is cancer that had responded to first-line platinum based chemotherapy but has returned between 6 and 12 months after finishing first-line treatment.

These scenarios can be used to help you and your oncologist decide which drugs to give you in second-line chemotherapy. Other factors to be considered include:

how you responded to the drug before;
possible side effects;
whether you have an allergy to platinum-based drugs; and
the likely benefits of the drug.

Your oncologist should discuss the risks and benefits of each treatment option with you before making any decision on second-line or subsequent chemotherapy.

If you have any queries or wish to discuss these options before making your decision , please call our nurse-led support line on 0845 371 0554. You may also wish to speak at greater length with your oncology nurse.