Ovarian cancer research

• A quick guide to what's on this page
• Why research?
• Prevention and early detection
• Chemotherapy
• Biological therapies

• Hormone treatment
• CA125 testing as routine follow up
• Fertility drugs
• Support from other patients
• Helping with bowel problems after radiotherapy

All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that

• We can be sure they work
• We can be sure they work better than the treatments that are available at the moment
• They are known to be safe

First of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.

Tests in patients are called clinical trials. There are 4 phases of clinical trials. This is fully explained in the understanding clinical trials section of CancerHelp UK. If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials recruiting in the UK. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team.

All the new approaches covered here are the subject of ongoing research. Until studies are completed and new effective treatments are found, these potential new treatments cannot be used as standard therapy for ovarian cancer.

This section has information on

• Screening for ovarian cancer
• BRCA 1 and 2 genes
• HRT and ovarian cancer risk
• The pill and ovarian cancer risk
• Aspirin and ovarian cancer risk

Screening for ovarian cancer

At the moment, there is no screening test reliable enough to use for ovarian cancer in the general population. But clinical trials are looking into screening for

• Women at high risk of cancer of the ovary
• Women in general

Two main tests are used in these screening trials

• A blood test for CA125
• A transvaginal ultrasound scan

Until we get results from these trials, we won't know whether these screening tests work or not.

There is more information about screening for ovarian cancer in CancerHelp UK. And for screening trials going on in the UK, you can look on our clinical trials database. Click on the drop down menu and choose ‘ovarian’.

BRCA 1 and 2 genes 

We can now test for two gene faults involved in ovarian cancer. If you have breast cancer and ovarian cancer in your family, it may be that people in your family are carrying a fault in one of the cancer genes BRCA1 or BRCA2. If you have one of these gene faults, you have an increased risk of breast and ovarian cancer. Do remember that these genes are only likely to be the cause of cancer in a very few families.

Research is always going on into the relationship between BRCA1 and BRCA2 gene mutations and an increased risk of ovarian cancer. The Familal Ovarian Cancer Registry is currently studying families where at least 2 relatives have (or have had) ovarian cancer. The researchers want to find out more about the causes of ovarian cancer, including the part that faulty BRCA genes play. There is more information about trials for women with faulty BRCA1 or BRCA2 genes on our clinical trials database. Choose 'ovarian' from the drop down list of cancer types.

This information is helping women to make difficult decisions about prevention of ovarian cancer. For example, scientists have been able to estimate the number of years of life that an average woman with a BRCA mutation might gain by having both her ovaries taken out (to prevent ovarian cancer developing). Although this might be useful to know, it is only a guide. Statistics like these can only predict the outcome of a group of many women, and not what will happen to any individual woman.

HRT and ovarian cancer risk

Women who use HRT have an increased risk of developing ovarian cancer and of dying of ovarian cancer. But the increase in risk is very small. Results of the Million Women study released in April 2007 showed that over 5 years there is one extra case of ovarian cancer in every 2500 women who take HRT. And for every 3300 women who take HRT, one more will die than in the same number of women who do not take HRT. When women stop taking HRT, their risk of developing ovarian cancer goes down to normal after a few years.

The pill and ovarian cancer risk

Taking the pill is known to lower the risk of getting ovarian cancer for the average woman. But we don't know if the pill can lower the risk for women who carry a gene that increases their risk. Researchers are looking into this. There is a small increase in risk of developing breast cancer while taking the pill and for a short time afterwards.

Aspirin and ovarian cancer risk

Some studies have shown that people who take regular aspirin are slightly less likely to develop ovarian cancer and other types of cancers. This is also true for people taking drugs from the same group as aspirin - these are called non steroidal anti-inflammatory drugs (NSAIDs). We need much more research before we know whether this is true and if so, how much aspirin to take and how much it will help protect you.

Remember - aspirin and other anti-inflammatory drugs can be dangerous. You should not take them regularly without checking with your doctor. This is particularly true if you have any history of stomach ulcer, bleeding disorders or are taking drugs to stop your blood clotting, such as warfarin, heparin or coumadin.

Past trials have found which chemotherapy drugs work well for ovarian cancer. But current trials are testing when the best time to give chemotherapy is, what the best combinations and doses of drugs are, and if different ways of giving chemotherapy are possible. There is information below on

• Chemotherapy before surgery
• Different doses and combinations of drugs
• Preventing resistance to chemotherapy
• Chemotherapy into your abdomen
• Finding out who chemo will work best for

Chemotherapy before surgery

Doctors are looking at giving chemotherapy before surgery in ovarian cancer. This is called neoadjuvant chemotherapy. One study is called CHORUS and you can find out more about this trial on our clinical trials database. Choose 'ovarian' from the drop down list of cancer types.

Different doses and combinations of drugs

Chemotherapy drugs being used in trials include

• Carboplatin
• Paclitaxel (Taxol)
• Gemcitabine
• Oxaliplatin
• Trabectedin (Yondelis)
• Topotecan (Hycamtin)
• Cisplatin
• Liposomal doxorubicin (Caelyx)

A trial called SCROTOC 4 that has now closed is looking at the best dose of the chemotherapy drug carboplatin to use for women with ovarian cancer. We are waiting for the results. The Neo-ESCAPE trial is investigating whether it is better to have paclitaxel and carboplatin together or separately, and which one works better with gemcitabine. You may be able to join this trial if your cancer cannot be removed surgically when you are diagnosed. If the chemotherapy shrinks the cancer enough, you might be able to have surgery later.

Trials that are open are listed on our clinical trials database. Choose 'ovarian' from the drop down list of cancer types.

A trial has compared a combination of decitabine and carboplatin chemotherapy with carboplatin alone, as treatment for ovarian cancer that has come back after it was first treated. This trial is no longer recruiting patients, and we are waiting for the results. The ET743-OVA-301 trial looked at treatment for women with ovarian cancer that had come back after initial treatment. It compared liposomal doxorubicin alone with the combination of liposomal doxorubicin (also called Caelyx or Doxcil) and Yondelis (also called ET743 or trabectedin). The researchers found that having both drugs controlled the growth of the cancer for longer than having just liposomal doxorubicin on its own.

Preventing resistance to chemotherapy

A treatment is being tried to see if it can stop advanced ovarian cancers becoming resistant to chemotherapy. Doctors usually treat ovarian cancer with surgery and chemotherapy. Carboplatin is a drug that doctors often use. If it works well for you, doctors may suggest having it again if your cancer comes back. But unfortunately, ovarian cancer can stop responding to this type of chemotherapy. This is called resistance to treatment.

Phenoxodiol is a new drug that may be able to make resistant cancer cells respond to chemotherapy drugs again. Researchers are using phenoxodiol alongside carboplatin for advanced ovarian cancer to see if it works better than carboplatin on its own. This trial has closed and we are waiting for the results.

Chemotherapy into your abdomen

This is called 'intraperitoneal' chemotherapy or IP chemotherapy. To have this type of treatment, you have one or two plastic tubes put into your abdomen. You then have the chemotherapy drugs put into your abdomen through the tube. If you have two tubes, the chemotherapy is circulated in through one tube and out through the other. In some research in this area, the solution containing the drugs is heated as the researchers believe this helps the chemotherapy to kill more cancer cells.

The idea of this type of treatment is that the chemotherapy reaches any cancer cells in your abdomen in a higher concentration than it would via the bloodstream. This treatment was being researched a few years ago and is now being looked into again in the USA and Japan. Some trials have shown that this type of treatment may be useful, but any advantages have to be weighed up against the demands of having the treatment, and the side effects. Trials using intraperitoneal chemotherapy in the UK are planned.

Finding out who chemo will work best for

Some women with ovarian cancer respond better to chemotherapy than others. Doctors hope that by looking for certain changes in the cancer cells' genes, they can find out who will benefit most from standard chemotherapy after surgery. And who might be better off having a different treatment. They will do this by taking tissue samples during surgery. This study is called the DNA methylation study, and there is more information about it on our clinical trials database.

Biological therapies are therapies that use substances that the body naturally produces. There is information here about

• Cancer growth blockers
• Blood supply and ovarian cancer
• PARP-1 inhibitors

Cancer growth blockers

Cancer growth blockers block substances that cells use to signal to one another to grow. Some of the substances that make cells grow are called ‘ tyrosine kinases’. So drugs that block them are called tyrosine kinase inhibitors or TKIs.

Erlotinib (also called Tarceva) is a tyrosine kinase inhibitor. There has been a trial to see if taking erlotinib for up to 2 years after chemotherapy helps to stop ovarian cancer coming back. This trial is no longer recruiting patients, and we are waiting for the results.

Blood supply and ovarian cancer

Angiogenesis means growth of new blood vessels. Cancers need to grow their own blood vessels as they get bigger. Without its own blood supply, a cancer cannot continue to grow. Anti-angiogenic drugs stop tumours from developing their own blood vessels. So the cancer cells can't get the oxygen and food that they need in order to grow.

Another drug which disrupts the tumour's blood supply is called cediranib (also known as Recentin or AZD2171). A large trial called ICON 6 is looking at whether adding cediranib to standard chemotherapy can work better for ovarian cancer that comes back after initial treatment. There is information about this trial on our clinical trials database. Choose 'ovarian' from the drop down list of cancer types.

Researchers are also testing drugs that may block the blood supply to the tumour by disrupting the small blood vessels that supply it. A phase 2 trial has been testing the drug combretastatin with chemotherapy for advanced ovarian cancer. The researchers want to find out how well this combination works. This trial is no longer recruiting patients, and we are waiting for the results.

Another drug that affects the blood vessels that supply cancer cells is DMXAA (also known as AS1404). A phase II study testing DMXAA with carboplatin and paclitaxel chemotherapy for advanced ovarian cancer has recently closed in the UK. Another Phase II trial looked at the growth factor inhibitor BIBF 1120 for advanced ovarian cancer. BIBF 1120 is a new type of drug designed to block angiogenesis. This trial is no longer recruiting and we are waiting for the results.

One drug which disrupts the growth of blood vessels is called bevacizumab (Avastin). This is a type of drug known as a monoclonal antibody. A large, phase 3 trial called ICON 7 has been checking whether adding bevacizumab (Avastin) to standard chemotherapy can lower the risk of ovarian cancer, primary peritoneal or fallopian tube cancer coming back. This trial is no longer recruiting patients and we are waiting for the results.

PARP-1 inhibitors

One trial is testing a drug called AG-014699 in women with ovarian cancer who have a faulty BRCA1 or BRCA2 gene. You may be able to take part in this trial if you have stage 3 or 4advanced ovarian cancer. AG-014699 is a 'PARP-1 inhibitor'. PARP-1 is an enzyme which helps damaged cells (including cancer cells) to repair themselves.

Another study is looking at a new biological therapy called olaparib (AZD2281) to see if it can help to control serous type epithelial ovarian cancer after surgery and chemotherapy. Doctors hope that if they can stop PARP working, cancer cells won't be able to repair themselves after chemotherapy. Another trial is testing a new form of AZD2281 tablets compared to AZD2281 capsules for advanced cancers, including breast or ovarian cancer in people with BRCA gene faults. There is information about these trials on our clinical trials database. We also have information about olaparib in our question and answer section.

Doctors have been looking at the hormone treatment tamoxifen to treat advanced ovarian cancer. Tamoxifen is an important drug for treating breast cancer. A few studies have tested tamoxifen for women who have advanced ovarian cancer where chemotherapy treatment has not worked. These studies showed that tamoxifen worked for a small number of women. But until larger trials are done we don't know for sure how helpful it is in treating ovarian cancer.

In over 8 out of 10 people (85%), it is possible to tell that ovarian cancer has come back (recurred) by testing CA125 levels in the blood. The rise in this cancer marker can show up the cancer recurrence before there are any symptoms. But we don't know whether finding and treating this recurrence sooner rather than later helps. There is no evidence that it makes any difference to how well women stay and for how long. They may just know about the cancer for longer. The testing may cause unnecessary anxiety. And early treatment means having chemotherapy at a time when you would otherwise be well.

A clinical trial called OV05 looked at how useful routine CA125 testing is as part of routine follow up. The trial found that giving treatment as soon as the cancer starts to grow back is no more effective than waiting to give treatment when symptoms develop. So now many doctors prefer to wait and give treatment if you develop symptoms, rather than doing regular CA125 tests.

Over ten years ago there was a lot of publicity surrounding a study that seemed to show that using fertility drugs increased the risk of ovarian cancer. This led to a lot of concern among women who had taken these drugs. More extensive research has been done since. None of the studies has shown a definite link between fertility treatment and increasing your risk of ovarian cancer, although the results are conflicting.

Many women have said that getting emotional support when they have gynaecological cancer has helped them to cope. But there is little scientific evidence to back this up. A small study in London has been looking at the difference that this kind of support can make. Women in one group are contacted by a woman who has had similar treatment, and had special training in giving support. The other group go on a waiting list for this kind of support. All women in the study are asked to fill in some questionnaires. The researchers want to find out how helpful this service is for women with gynaecological cancer. This study is no longer recruiting patients and we are waiting for the results.

A trial is looking at whether using a high pressure oxygen treatment called hyberbaric oxygen (HBO) therapy can help to relieve the long term side effects of having radiotherapy to the pelvic area. Most side effects will get better a few months after treatment has finished. But for a small number of people the side effects may be long lasting. Many of the long term side effects of pelvic radiotherapy affect the bowel. These include frequent bowel movements, diarrhoea, pain, bleeding from the bowel and the forming of scar tissue in the bowel (radiation fibrosis).

You may be able to join this trial if you still have bowel problems caused by radiotherapy you had at least a year ago, and you have no signs of cancer now. Everyone on this trial will go to one of the specialist centres taking part in this study to have hyperbaric oxygen therapy (HBO). You go every day, 5 days a week (Monday to Friday), for 8 weeks. Each treatment takes about an hour and a half. There are 2 groups in this trial. One will have 100% oxygen under pressure, the other will have 21% oxygen (the same as air) under pressure. Neither you nor your doctor will know which group you are in.

To have HBO, you sit inside a chamber on your own or with up to 5 other patients and a qualified attendant, depending on the size of the chamber at the specialist centre. The chamber is sealed, but has small windows. There is a doctor just outside the whole time. There is information about this trial on our clinical trials database.