The Latest Advances in Ovarian Cancer Treatment

Ovarian cancer has long been thought of as a cancer that is difficult to treat, particularly after it has recurred or spread. 

Now, however, patients have more treatment options than ever before. 

Dana-Farber investigators and others in the field have driven advances in imaging, treatment, and post-treatment maintenance therapy that are helping patients experience longer periods of time before the cancer recurs. In addition, if the cancer does come back, there are many new therapies available including approved therapies and clinical trials of innovative medicines. 

“If this disease comes back, and regrettably it can, there are so many more options today than there were yesterday,” says Dana-Farber gynecologic oncologist Susan Campos, MD, MPH. “There is a security to knowing that there are options out there. Even if you don’t need those options today, knowing they are there is priceless.” 

Advances in understanding of inherited BRCA1/2 risk genes 

Today, every patient diagnosed with ovarian cancer should receive genetic testing to determine if they have an inherited risk of the disease. The risk of ovarian, breast, pancreatic, and prostate cancer goes up in people who have inherited mutations in specific genes. 

The most familiar genes that can carry these mutations are BRCA1 and BRCA2, but in recent years, scientists have learned that there are other, related gene mutations that also increase the risk of ovarian cancer. These mutations are called homologous repair defects (HRD). Patients with BRCA1/2 or other HRD gene mutations are typically given different or additional medicines as part of treatment or therapy after treatment, called maintenance therapy. 

PARP inhibitors as maintenance therapy for BRCA1/2-positive ovarian cancer 

In the past decade, clinical studies have led to the approval of PARP inhibitors to reduce the risk of recurrence after initial treatment for patients with HRD-positive cancers, including BRCA1/2 mutations. 

Today, there are two PARP inhibitors approved for maintenance therapy for patients with BRCA/HRD-positive risk genes.  

Advances in targeted therapies for ovarian cancer 

Novel therapies called antibody-drug conjugates (ADCs) combine cancer-targeting drugs with potent chemotherapy drugs. The result is the delivery of powerful drugs directly into the cancer. 

There are two antibody-drug conjugates that are U.S. Food and Drug Administration (FDA) approved for the treatment of ovarian cancer that is no longer responding to platinum-based chemotherapy. One ADC is called mirvetuximab-soravtansine-gynx which targets the folate receptor. Another ADC is called trastuzumab-deruxtecan (T-DXd) which targets HER2. 

Antibody-drug conjugates are matched to patients with cancers that have the right biomarkers for the therapy.  

“At Dana-Farber, every patient receives next-generation sequencing of their tumor samples so we can learn what molecular aberrations are present and make the best treatment choices,” says Campos.  

Dana-Farber investigators and others are pursuing several areas of research involving ADCs, including: 

• Novel ADCs are being tested in clinical trials for patients with ovarian cancer that has recurred. Your care team can help determine if there is a clinical trial that is a good match for you. 

• FDA-approved ADCs are being tested in earlier lines of therapy, such as in patients who are still sensitive to chemotherapy. These clinical trials aim to determine if ADCs or combination therapies that involve them might outperform chemotherapy.  

• FDA-approved ADCs are being tested as maintenance therapy after chemotherapy to see if they extend the period that patients remain disease-free. 

Dana-Farber clinician-scientists have played leadership roles in the approvals of ADCs for ovarian cancer and are playing instrumental roles in investigations of novel ADCs in different scenarios. 

“Some of the most exciting advances involve testing these ADCs and novel combinations in platinum-resistant disease. Some of these ADCs are being explored as maintenance therapy,” says Campos. “There’s a lot on the horizon.” 

Up and coming therapies for ovarian cancer 

Dana-Farber investigators are also exploring several innovative therapies for ovarian cancer: 

• Investigators are exploring combinations of chemotherapies, PARP inhibitors, immunotherapies, and other therapies to see if combination treatments improve outcomes. 

• Medicines that short-circuit quality controls in cancers cells and make them more likely to die are being explored in ovarian cancer treatment and maintenance therapy. These medicines include Wee-1 inhibitors and other medicines that target a phenomenon called replication stress. 

• Novel personalized cancer vaccines built on the Dana-Farber NeoVax platform are being tested to determine if they help stave off ovarian cancer recurrence.  

• The first trial of a cellular therapy called NK cell therapy is also being tested in ovarian cancer to determine if it can amplify the immune system’s fight against the cancer. 

About the Medical Reviewer

Dr. Campos received her MD from Georgetown University in 1992, and then completed residency training at Georgetown Medical Center. Between 1995 and 1998, she completed a fellowship in hematology-oncology at Brigham and Women's Hospital, in Boston, and in 2000 received her MPH from Harvard Medical School. She serves on committees for the American Society of Clinical Oncology, the Gynecological Oncology Group, and the National Comprehensive Cancer Network. She is board-certified in internal medicine, oncology, and hematology.