Platinum-sensitive ovarian cancer: the decisions you may face
5 treatment settings, 5 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
First-line maintenance, BRCA-mutant
Olaparib for two years (SOLO-1), or olaparib with bevacizumab (PAOLA-1); niraparib as an alternative.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
Niraparib is a PARP inhibitor approved as maintenance for ovarian cancer regardless of BRCA status, and in prostate cancer with abiraterone.
Pills that block a DNA repair backup, killing cancer cells that already lost their main repair system (BRCA).
- Oral, targeted to a germline-definable population
- Overall survival benefit in adjuvant setting
- Tests Olaparib, PARP inhibitorsNewly diagnosed advanced BRCA-mutated ovarian cancer in response to platinum chemotherapy: olaparib maintenance for 2 years vs placebo
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- PFS HR 0.30; 7-year OS 67.0% vs 46.5% (HR 0.55).
- Tests OlaparibNewly diagnosed advanced ovarian cancer already on bevacizumab maintenance: adding olaparib vs placebo
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- PFS HR 0.59 overall, 0.33 HRD-positive; 5-year OS 65.5% vs 48.4% in HRD-positive.
Progression-free survival (HRD-positive) (months): Olaparib + bevacizumab 37.2 vs Placebo + bevacizumab 17.7 · HR 0.33 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
- Avoid grapefruit and Seville oranges.
- 200 mg twice daily for CrCl 31-50.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Thrombocytopenia · PRIMA | 66% | 38% |
| Anaemia · PRIMA | 65% | 31% |
| Neutropenia · PRIMA | - | 17% |
| Nausea · PRIMA | 62% | - |
- Not CYP-metabolised (carboxylesterases), so few pharmacokinetic interactions. Hypertension and tachycardia: monitor blood pressure weekly for 2 months.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Myelosuppression, MDS risk
- Reversion resistance
- Between Olaparib, Niraparib and PARP inhibitors, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in SOLO-1 and PAOLA-1 / ENGOT-ov25, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Olaparib or Niraparib are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (first-line maintenance, brca-mutant), which of the standard options do you recommend and why?Why: Guideline options include: Olaparib for two years (SOLO-1), or olaparib with bevacizumab (PAOLA-1); niraparib as an alternative.
- Am I a candidate for Olaparib, Niraparib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of SOLO-1 and PAOLA-1 / ENGOT-ov25 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
First-line maintenance, HRD-positive BRCA-wild-type
Olaparib plus bevacizumab (PAOLA-1) or niraparib (PRIMA) after HRD testing.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
Bevacizumab is a humanised antibody that soaks up VEGF-A, the signal tumours use to grow new blood vessels. Approved in 2004, it partners chemotherapy in colorectal, ovarian, cervical, lung, kidney and liver cancer and glioblastoma, and adds to trifluridine/tipiracil in late-line bowel cancer; hypertension, protein in the urine and bleeding are its characteristic side effects.
Niraparib is a PARP inhibitor approved as maintenance for ovarian cancer regardless of BRCA status, and in prostate cancer with abiraterone.
Tests that reveal whether a tumour has a broken DNA repair system, which predicts response to PARP inhibitors and platinum.
- Extends PARP-inhibitor benefit beyond BRCA carriers
- Tests Olaparib, BevacizumabNewly diagnosed advanced ovarian cancer already on bevacizumab maintenance: adding olaparib vs placebo
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- PFS HR 0.59 overall, 0.33 HRD-positive; 5-year OS 65.5% vs 48.4% in HRD-positive.
Progression-free survival (HRD-positive) (months): Olaparib + bevacizumab 37.2 vs Placebo + bevacizumab 17.7 · HR 0.33 · source - Tests NiraparibNewly diagnosed advanced ovarian cancer at high risk of relapse, any BRCA/HRD status: niraparib maintenance vs placebo
PFS HR 0.62 overall, 0.43 HRD-positive; final OS HR 1.01.
Progression-free survival (HRD-positive) (months): Niraparib 21.9 vs Placebo 10.4 · HR 0.43 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
- Avoid grapefruit and Seville oranges.
- 200 mg twice daily for CrCl 31-50.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Thrombocytopenia · PRIMA | 66% | 38% |
| Anaemia · PRIMA | 65% | 31% |
| Neutropenia · PRIMA | - | 17% |
| Nausea · PRIMA | 62% | - |
- Not CYP-metabolised (carboxylesterases), so few pharmacokinetic interactions. Hypertension and tachycardia: monitor blood pressure weekly for 2 months.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Scar is permanent even after resistance emerges
- Threshold debates
- Between Olaparib, Bevacizumab, Niraparib and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in PAOLA-1 / ENGOT-ov25 and PRIMA / ENGOT-OV26, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Olaparib or Niraparib are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (first-line maintenance, hrd-positive brca-wild-type), which of the standard options do you recommend and why?Why: Guideline options include: Olaparib plus bevacizumab (PAOLA-1) or niraparib (PRIMA) after HRD testing.
- Am I a candidate for Olaparib, Bevacizumab, Niraparib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PAOLA-1 / ENGOT-ov25 and PRIMA / ENGOT-OV26 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
First-line maintenance, HRD-negative
Niraparib (PRIMA, smaller benefit) or bevacizumab; observation is reasonable after discussion.
Niraparib is a PARP inhibitor approved as maintenance for ovarian cancer regardless of BRCA status, and in prostate cancer with abiraterone.
Bevacizumab is a humanised antibody that soaks up VEGF-A, the signal tumours use to grow new blood vessels. Approved in 2004, it partners chemotherapy in colorectal, ovarian, cervical, lung, kidney and liver cancer and glioblastoma, and adds to trifluridine/tipiracil in late-line bowel cancer; hypertension, protein in the urine and bleeding are its characteristic side effects.
- Tests NiraparibNewly diagnosed advanced ovarian cancer at high risk of relapse, any BRCA/HRD status: niraparib maintenance vs placebo
PFS HR 0.62 overall, 0.43 HRD-positive; final OS HR 1.01.
Progression-free survival (HRD-positive) (months): Niraparib 21.9 vs Placebo 10.4 · HR 0.43 · source - Tests BevacizumabNewly diagnosed advanced ovarian cancer: carboplatin-paclitaxel ± bevacizumab with bevacizumab maintenance
GOG-0218 PFS 14.1 vs 10.3 months (HR 0.72); no OS benefit.
Progression-free survival (GOG-0218) (months): Bevacizumab throughout 14.1 vs Chemotherapy alone 10.3 · HR 0.72 · source
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Thrombocytopenia · PRIMA | 66% | 38% |
| Anaemia · PRIMA | 65% | 31% |
| Neutropenia · PRIMA | - | 17% |
| Nausea · PRIMA | 62% | - |
- Not CYP-metabolised (carboxylesterases), so few pharmacokinetic interactions. Hypertension and tachycardia: monitor blood pressure weekly for 2 months.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Between Niraparib and Bevacizumab, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in PRIMA / ENGOT-OV26 and GOG-0218 & ICON7 (bevacizumab), and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Niraparib are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (first-line maintenance, hrd-negative), which of the standard options do you recommend and why?Why: Guideline options include: Niraparib (PRIMA, smaller benefit) or bevacizumab; observation is reasonable after discussion.
- Am I a candidate for Niraparib, Bevacizumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PRIMA / ENGOT-OV26 and GOG-0218 & ICON7 (bevacizumab) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
First platinum-sensitive relapse
Secondary cytoreduction in AGO-score-positive patients (DESKTOP III), then carboplatin doublet with pegylated liposomal doxorubicin, gemcitabine or paclitaxel, bevacizumab if not previously given, and PARP inhibitor maintenance if PARP-naive.
Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.
Doxorubicin wrapped in a fatty bubble so it reaches tumours with less heart damage; a workhorse of relapsed ovarian cancer.
A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.
A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.
Bevacizumab is a humanised antibody that soaks up VEGF-A, the signal tumours use to grow new blood vessels. Approved in 2004, it partners chemotherapy in colorectal, ovarian, cervical, lung, kidney and liver cancer and glioblastoma, and adds to trifluridine/tipiracil in late-line bowel cancer; hypertension, protein in the urine and bleeding are its characteristic side effects.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
Niraparib is a PARP inhibitor approved as maintenance for ovarian cancer regardless of BRCA status, and in prostate cancer with abiraterone.
A PARP inhibitor for BRCA-mutated ovarian and prostate cancer whose original maker went bankrupt; still available, with a narrowed label.
- First platinum-sensitive relapse with a positive AGO score: secondary cytoreductive surgery + chemotherapy vs chemotherapy alone
OS 53.7 vs 46.0 months (HR 0.75).
Overall survival (months): Surgery + chemotherapy 53.7 (n=206) vs Chemotherapy alone 46 (n=201) · HR 0.75 · source
- Dose by Calvert formula using GFR (see the calculators).
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
- Avoid grapefruit and Seville oranges.
- 200 mg twice daily for CrCl 31-50.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Thrombocytopenia · PRIMA | 66% | 38% |
| Anaemia · PRIMA | 65% | 31% |
| Neutropenia · PRIMA | - | 17% |
| Nausea · PRIMA | 62% | - |
- Not CYP-metabolised (carboxylesterases), so few pharmacokinetic interactions. Hypertension and tachycardia: monitor blood pressure weekly for 2 months.
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Between Carboplatin, Pegylated liposomal doxorubicin, Gemcitabine and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in DESKTOP III / ENGOT-ov20, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- Which side effects of Olaparib or Niraparib are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (first platinum-sensitive relapse), which of the standard options do you recommend and why?Why: Guideline options include: Secondary cytoreduction in AGO-score-positive patients (DESKTOP III), then carboplatin doublet with pegylated liposomal doxorubicin, gemcitabine or paclitaxel, bevacizumab if not previously given, and PARP inhibitor maintenance if PARP-naive.
- Am I a candidate for Carboplatin, Pegylated liposomal doxorubicin, Gemcitabine or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of DESKTOP III / ENGOT-ov20 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.
Relapse after PARP inhibitor
Platinum doublet; PARP rechallenge has limited benefit; trials of ATR, WEE1 and next-generation PARP1-selective inhibitors.
Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.
Saruparib is an experimental small-molecule drug from AstraZeneca in phase 3 trials for prostate cancer, ovarian cancer and non-small-cell lung cancer, aimed at PARP.
- Newly diagnosed advanced ovarian cancer after response to first-line platinum: rucaparib maintenance vs placebo
PFS 20.2 vs 9.2 months (HR 0.52).
Progression-free survival (ITT) (months): Rucaparib 20.2 (n=427) vs Placebo 9.2 (n=111) · HR 0.52 · source
- Dose by Calvert formula using GFR (see the calculators).
- Between Carboplatin and Saruparib, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in ATHENA-MONO / GOG-3020, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (relapse after parp inhibitor), which of the standard options do you recommend and why?Why: Guideline options include: Platinum doublet; PARP rechallenge has limited benefit; trials of ATR, WEE1 and next-generation PARP1-selective inhibitors.
- Am I a candidate for Carboplatin, Saruparib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ATHENA-MONO / GOG-3020 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.