Understanding Maintenance Treatment

Wait or act?

One option you have after cancer has responded to chemotherapy is to watch and wait. This approach involves monitoring your health by visiting your doctor regularly to have tests and exams rather than taking medicine or having medical treatments.1,2

To help extend the time before cancer returns, another choice is maintenance treatment.

Maintenance treatment is given after a positive response to chemotherapy to help keep cancer from returning. Even after a period of remission, or positive response, the cancer can still be there in microscopic amounts.2-4


Choosing maintenance treatment is one way you can take an active role in your care.5

Active therapy after chemotherapy was a plan that worked for Teri. The idea of oral therapy with ZEJULA came as a relief to her.

What is maintenance treatment?

Maintenance treatment is different from traditional chemotherapy. It may help keep cancer from returning after successful chemotherapy, extending your time in response.3,6

One method of maintenance treatment is PARP inhibition. PARP, or poly(ADP-ribose) polymerase, is a protein that helps repair damaged DNA in healthy cells.2,7

Cancer cells also use PARP to help fix broken DNA, which helps keep the cancer cells alive.8-10

Healthy cells and cancer cells - 1

In healthy cells, DNA damage occurs and is repaired by proteins, such as PARP, so the cell can continue to function. This damage can be spontaneous or can be a result of external exposures like sunlight or radiation or some chemicals.7,9,11,12

Healthy cells and cancer cells - 2

Cancer cells work in a similar way to healthy cells. They also experience damage to their DNA, just like healthy cells, and use proteins such as PARP to repair the damaged DNA.7,8,13,14

Healthy cells and cancer cells - 3

PARP inhibitors block the protein PARP. That means the damaged DNA can’t be repaired in the cancer cell, so the DNA accumulates more and more damage, a signal that can lead to the death of the cancer cell.7,9,11

PARP inhibitors can help prevent cancer cells from repairing their damaged DNA, which can cause cancer cells to die. This may slow the return or the progression of cancer.7,11

Talk to your doctor about treatment that offers you a chance for more days without your cancer progressing.

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References: 1. NCI Dictionary of Cancer Terms: Watchful Waiting. National Cancer Institute website. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ watchful-waiting. Accessed April 9, 2018. 2. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Ovarian Cancer v2.2018. © National Comprehensive Cancer Network, Inc. 2018. All rights reserved. Accessed May 4, 2018. To view the most recent and complete version of the guideline, go online to NCCN.org. 3. NCI Dictionary of Cancer Terms: Maintenance Therapy. National Cancer Institute website. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/maintenance-therapy. Accessed May 3, 2018. 4. Recurrence. Ovarian Cancer Research Fund Alliance website. https://ocrfa.org/patients/about-ovarian-cancer/recurrence/. Accessed May 3, 2018. 5. Schulman-Green D, Bradley EH, Nicholson NR Jr, George E, Indeck A, McCorkle R. One step at a time: self-management and transitions among women with ovarian cancer. Oncol Nurs Forum. 2012:39(4):354-360. 6. Khalique S, Hook JM, Ledermann JA. Maintenance therapy in ovarian cancer. Curr Opin Oncol. 2014;26(5):521-528. 7. NCI Dictionary of Cancer Terms: PARP. National Cancer Institute website. https://www.cancer.gov/publications/dictionaries/cancer-terms/search?contains=false&q=parp. Accessed May 3, 2018. 8. Jubin T, Kadam A, Jariwala M, et al. The PARP family: insights into functional aspects of poly(ADP-ribose) polymerase-1 in cell growth and survival. Cell Prolif. 2016;49(4):421-437. 9. Davar D, Beumer JH, Hamieh L, Tawbi H. Role of PARP inhibitors in cancer biology and therapy. Curr Med Chem. 2012;19(23):3907-3921. 10. Brown JS, O'Carrigan B, Jackson SP, Yap TA. Targeting DNA repair in cancer: beyond PARP inhibitors. Cancer Discov. 2017:7(1):20-37. 11. ZEJULA [package insert). Waltham, MA: TESARO, Inc; 2018. 12. Cooper GM. DNA repair. In: The Cell. 2nd ed. Sunderland, MA: Sinauer Associates; 2000. https://www.ncbi.nlm.nih.gov/books/NBK9900/. Accessed May 29, 2018. 13. Lodish H, ed. Tumor cells and the onset of cancer. In: Molecular CelI Biology. 4th ed. New York, NY: Freeman: 2002. https://www.ncbi.nlm.nih.gov/books/. Accessed May 29, 2018. 14. Ciccia A, Elledge SJ. The DNA damage response: making it safe to play with knives. Mol Cell. 2010:40(2):179-204.

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