The first 60 days: Platinum-sensitive ovarian cancer
Platinum-sensitive ovarian cancer is disease that responded to carboplatin and either has not relapsed or relapses more than six months after the last dose. It is treated with further platinum chemotherapy, sometimes repeat surgery, and above all with maintenance PARP inhibitors, which keep BRCA-mutant tumours away for years and have raised long-term survival. Below, week by week, is what OnCo's record of Platinum-sensitive ovarian cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: First-line maintenance, HRD-positive BRCA-wild-type.
- Medical oncologistNamed in the standard of care for: First-line maintenance, BRCA-mutant, First-line maintenance, HRD-positive BRCA-wild-type, First-line maintenance, HRD-negative, First platinum-sensitive relapse and 1 more.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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.
Platinum doublet; PARP rechallenge has limited benefit; trials of ATR, WEE1 and next-generation PARP1-selective inhibitors.
Olaparib for two years (SOLO-1), or olaparib with bevacizumab (PAOLA-1); niraparib as an alternative.
Olaparib plus bevacizumab (PAOLA-1) or niraparib (PRIMA) after HRD testing.
Niraparib (PRIMA, smaller benefit) or bevacizumab; observation is reasonable after discussion.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Platinum-free interval, Germline and somatic BRCA1 and BRCA2, HRD genomic instability score, CA-125 kinetics, AGO score for secondary surgery), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Newly diagnosed advanced disease in response to first-line platinum, BRCA1 or BRCA2-mutant, platinum-sensitive, HRD-positive, BRCA-wild-type.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
First-line maintenance, BRCA-mutant
- For my situation (first-line maintenance, brca-mutant), which of the standard options do you recommend and 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?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?Trial populations differ from individual patients; ask how closely you match.
First-line maintenance, HRD-positive BRCA-wild-type
- For my situation (first-line maintenance, hrd-positive brca-wild-type), which of the standard options do you recommend and 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?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?Trial populations differ from individual patients; ask how closely you match.
First-line maintenance, HRD-negative
- For my situation (first-line maintenance, hrd-negative), which of the standard options do you recommend and 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?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?Trial populations differ from individual patients; ask how closely you match.
First platinum-sensitive relapse
- For my situation (first platinum-sensitive relapse), which of the standard options do you recommend and 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?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?Trial populations differ from individual patients; ask how closely you match.
Relapse after PARP inhibitor
- For my situation (relapse after parp inhibitor), which of the standard options do you recommend and 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?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?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Saruparib, ATR, WEE1, ctDNA-guided duration of PARP maintenance?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Whether HRD-negative tumours gain enough from PARP inhibitors to justify two to three years of treatment”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Resistance through BRCA reversion and restored homologous recombination”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Platinum-sensitive ovarian cancer: the full pagePlatinum-sensitive ovarian cancer is disease that responded to carboplatin and either has not relapsed or relapses more than six months after the last dose. It is treated with further platinum chemotherapy, sometimes repeat surgery, and above all with maintenance PARP inhibitors, which keep BRCA-mutant tumours away for years and have raised long-term survival.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Homologous recombination deficiency (HRD): A tumour that cannot properly repair double-strand DNA breaks, usually because of BRCA or related gene loss.
Every term links to the glossary.