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.3
What is maintenance treatment?
Maintenance treatment is a type of treatment that is given following a positive response to chemotherapy. In women with recurrent ovarian cancer, the goal is to help keep the 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 an important way to take an active role in your care, but it’s important to remember that every recurrent ovarian cancer patient’s treatment journey is unique to them.5 To understand the reasons why Anne and Debi decided maintenance therapy was right for them, watch their stories here.
Why consider maintenance treatment?
Maintenance treatment may help keep cancer from returning after successful chemotherapy. It can extend your time in response, regardless of your BRCA status.3,6 One method of maintenance treatment is using PARP inhibitors such as ZEJULA. In clinical trials, using PARP inhibitors improved progression-free survival in patients with recurrent ovarian cancer compared with patients who did not use a PARP inhibitor.6-8
What is a PARP inhibitor?
PARP, or poly(ADP-ribose) polymerase, is a protein that helps repair damaged DNA.9
PARP inhibitors work to stop PARP from repairing cancer cells. This may lead to cancer cell death. If ovarian cancer responds to platinum-based chemotherapy, a PARP inhibitor can cause DNA to accumulate damage, which can lead to the death of the cancer cell. PARP inhibitors can also have an impact on healthy cells.6,9,10
How do I take a PARP inhibitor?
The goal of maintenance therapy with PARP inhibitors is to delay the time to recurrence.3,6,9 All PARP inhibitors are given orally, which means you can take them at home. Patients typically continue treatment with them unless tolerability becomes an issue.6-8
How maintenance treatment with a PARP inhibitor works
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.9-12
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.9,13-15
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.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.9,11
Talk to your doctor about treatment that offers you a chance for more days without your cancer progressing.
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. Mirza MR, Monk BJ, Herrstedt J, et al; for the ENGOT-OV16/NOVA Investigators. Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer. N Engl J Med. 2016;375(22):2154-2164. 7. Pujade-Lauraine E, Ledermann JA, Selle F, et al; for the SOLO2/ENGOT-Ov21 investigators. Olaparib tablets as maintenance therapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol. 2017;18(9):1274-1284. 8. Coleman RL, Oza AM, Lorusso D, et al; ARIEL3 investigators. Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy. (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;390(10106):1949-1961. 9. 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. 10. 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. 11. ZEJULA [package insert]. Waltham, MA: GSK, Inc.; October 2019. 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. 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. 14. 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. 15. Ciccia A, Elledge SJ. The DNA damage response: making it safe to play with knives. Mol Cell. 2010;40(2):179-204.