This page discusses the use of chemotherapy for the treatment of ovarian cancer. For a thorough review of chemotherapy, please see the chemotherapy treatment monograph .

Cancer chemotherapy is the use of drugs to kill cancer cells. Unlike radiation and surgery, which are localized treatments, chemotherapy is a systemic treatment, meaning the drugs travel throughout the whole body. This means chemotherapy can reach cancer cells that may have spread, or metastasized, to other areas.

On the flip side, the side effects from the chemotherapy come from the fact that it destroys normal cells as well. The effectiveness of this therapy depends upon the difference in sensitivity between the cancer cells and your normal cells.

Chemotherapy is usually injected or infused into a vein, but some forms can be given by mouth. Your medical oncologist will tell you how many cycles or courses of chemotherapy are best for you. In most cases, chemotherapy is given after surgery for six cycles. There are some studies examining the appropriate number of cycles, and your doctor may ask you to participate in one of those trials. Sometimes, the cancer is too large to remove surgically and the doctor may give you chemotherapy first to make the cancer smaller so that it can all be removed during surgery. There is still some debate about whether it is better to have chemotherapy before or after surgery, but the standard at this time is to receive chemotherapy after surgery.

The side effects and amount of time required in your doctor’s office depend on the type of chemotherapy you receive, as well as how many cycles you receive and how often. The most common chemotherapy-associated side effects are:

  • Nausea and vomiting
  • Fatigue or tiredness
  • Hair loss
  • Decreased blood counts

Chemotherapy Drugs Used for Ovarian Cancer

  • Bleomycin (Blenoxane)
  • Cisplatin (Platinol-AQ)
  • Carboplatin (Paraplatin)
  • Etoposide (VePesid, Toposar, Etopophos)
  • Vinblastine (Oncovin)
  • Paclitaxel (Taxol, Onxol)
  • Cyclophosphamide (Cytoxan, Neosar)

Effectiveness

Epithelial ovarian cancer, by far the most common form of ovarian cancer, is treated with combination chemotherapy when it reaches advanced stages. If treatment is instituted after effective surgery, approximately 70% of women will respond, and 40% to 50% will have a complete regression. Recent studies achieved equal results with paclitaxel plus carboplatin and paclitaxel plus cisplatin, the former combination resulting in substantially less toxicity. Cyclophosphamide plus cisplatin gives poorer results. Similar treatment is given to women with more advanced disease, but the survival rate falls off steeply with Stage IV disease or if there is substantial tumor left after surgery.

Stage I epithelial ovarian cancer may receive single-agent cisplatin or platinum-containing drug combinations after surgery if the cancer appears aggressive under the microscope.

For germ cell cancers with stages I to III disease, combinations such as PVB (cisplatin, vinblastine, bleomycin) and BEP (bleomycin, etoposide, and cisplatin), given in three or four courses at 21-day intervals, have produced 95% long-term survival in patients.

Antibiotic Related Chemotherapy Agents

Common names include:

  • Bleomycin (Blenoxane)

Bleomycin is part of the BEP combination used initially to treat certain germ cell cancers of the ovary. A typical dose is 30 units of bleomycin given intravenously (IV) on days 2, 9, and 16 of each 21-day treatment cycle.

Possible side effects include:

  • Severe allergic reactions
  • Lung damage causing shortness of breath or stiffness of the lungs
  • Hair loss
  • Vomiting
  • Rashes
  • Fever
  • Chills
  • Weight loss

Platinum Related Drugs

Common names include:

  • Cisplatin (Platinol-AQ)
  • Carboplatin (Paraplatin)

Cisplatin is used alone for certain ovarian cancers and in combination with either cyclophosphamide or paclitaxel to treat advanced disease. Cisplatin is also the third member of the standard BEP regimen for germ cell cancers. Carboplatin is being tested as a substitute for cisplatin in this combination, due to its lower toxicity. Carboplatin has been shown to be as effective as cisplatin for epithelial ovarian cancer.

Possible side effects of platinum drugs include:

  • Life-threatening allergic reactions (rare)
  • Kidney damage (occurs only with cisplatin)
  • Hearing loss (most frequent with cisplatin)
  • Bone marrow damage
  • Liver damage
  • Nerve damage (most frequent with cisplatin)
  • Blood vessel damage

Epipodophyllotoxin

Common name:

  • Etoposide

The second member of BEP treatment for germ cell cancers, epipodophyllotoxin may be given on days 1 through 5 of each 21-day cycle.

Possible side effects of epipodophyllotoxin include:

  • Severe bone marrow suppression (low blood counts)
  • Severe allergic reactions
  • Nausea
  • Vomiting
  • Hair loss

Vinca Alkaloids

Common name:

  • Vinblastine (Oncovin)

Vinblastine is effective in treating malignant germ cell tumors of the ovary when combined with dactinomycin and cyclophosphamide (VAC).

Possible side effects of vinca alkaloids include:

  • Bone marrow damage
  • Irritation at injection site
  • Allergic reactions
  • Hair loss
  • Nausea, vomiting, diarrhea, constipation
  • Nerve damage (numbness or tingling or slowing of the GI system)
  • Seizures
  • Blindness
  • Breathing problems
  • Fever
  • Headache

Taxanes

Common names include:

  • Paclitaxel (Taxol, Onxol)

Paclitaxel combined with cisplatin or carboplatin is a favored regimen for treating epithelial cell ovarian cancer. It produces complete disease regression in about one-quarter of patients with Stage III disease and two-thirds of patients have a meaningful disease response.

Possible side effects of taxanes include:

  • Life-threatening allergic reactions (occur rarely with steroid premedication)
  • Heart damage
  • Bone marrow damage
  • Nerve damage (numbness and tingling of the feet and hands)
  • Nausea
  • Vomiting
  • Diarrhea
  • Unusual infections

Alkylating Agents

Common name:

  • Cyclophosphamide (Cytoxan, Neosar)

Cyclophosphamide interferes with the growth of cancer cells, which are eventually destroyed. Since cyclophosphamide may also affect the growth of normal body cells, other effects will also occur. Cyclophosphamide is given either by mouth or by injection.

Cyclophosphamide is combined with cisplatin in one treatment regimen for advanced epithelial cell ovarian cancer. However, substituting paclitaxel for cyclophosphamide appears to yield better results.

Possible side effects of cyclophosphamide include:

  • Cough or hoarseness
  • Fever or chills
  • Lower back or side pain
  • Missed menstrual periods
  • Painful or difficult urination
  • Darkening of skin and fingernails
  • Loss of appetite
  • Nausea or vomiting
  • Heart damage
  • Hair loss
  • Nausea, vomiting, diarrhea
  • Bladder damage
  • Damage to reproductive organs
  • Bone marrow damage
  • Lung damage

For a thorough review of chemotherapy, please see the chemotherapy treatment monograph .