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Ovarian cancer research

Women discussing ovarian cancer

This page of the ovarian cancer section is about research into the causes, prevention and treatments of cancer of the ovary. You can find the following information

 

A quick guide to what's on this page

Ovarian cancer research

All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know they are safe. First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to use are they tested in people, in clinical trials. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

Researchers are looking into

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating ovarian cancer section.

 

 

Why research?

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 treatments that are already in use
  • 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. Cancer Research UK supports a lot of UK laboratory research into cancer.

Tests in patients are called clinical trials. Cancer Research UK supports many UK and international clinical trials.

Our trials and research section has information about what trials are including information about the 4 phases of clinical trials. If you are interested in taking part in research, 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 it is suitable for you, your doctor will need to make the referral to the research team. The database also has information about closed trials and trial results.

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

 

Prevention and early detection

This section has information about research into

Screening for ovarian cancer

At the moment, there is no screening test reliable enough to use for ovarian cancer. Clinical trials have been looking into screening for

The 2 main tests looked at in these trials are

A trial called UKCTOCS has been looking at ovarian cancer screening in the general population between the ages of 50 to 74. It finished recruiting women in September 2005. The women who took part were selected at random from GP lists and then invited to join. This was so that the researchers got the most reliable results possible.

Over 200,000 women took part in this trial. Of those

  • One quarter had a blood test for the CA 125 tumour marker
  • One quarter had a transvaginal ultrasound scan
  • Half had no screening test - doctors call this the control group

The first phase of the results were published in March 2009. The screening tests found 58 cancers, but missed the cancer in another 12 women. About half the cancers they found were at an early stage. You can read the results for the UKCTOCS trial on our clinical trials database. The researchers are still following up the women in this study and are expected to present their final results in 2015.

Part of the PLCO (Prostate, Lung, Colorectal and Ovarian cancer) trial in America looked at screening for ovarian cancer between 1993 and 2001. Around 78,200 women took part in the trial. Around half had screening once a year, and the other half had no screening (usual care group). The results were published in 2011. Ovarian cancer was diagnosed in

  • 212 women in the screening group
  • 176 women in the usual care group

The stages of ovarian cancer diagnosed were similar in the 2 groups, with stage 3 and stage 4 the most common. The trial team found that screening did not reduce the number of women dying from the disease.

The UK Familial Ovarian Cancer Screening Study (UK FOCSS) is looking at screening women who are at a high risk of developing ovarian cancer because they have a family history of cancer of the ovary or breast, or they have family members with a known genetic fault (such as BRCA 1 or BRCA 2). It finished recruiting women in 2010.

Results from the first part of the UK FOCSS study showed that screening once a year was not so good at picking up early stage ovarian cancer in women at increased risk. The researchers thought it may be better to have screening more often. So from 2007, women taking part in the study had screening every 4 months. The researchers are now following up the women in the second part of this study. They plan to publish the final results in 2015.

From all these screening studies, researchers now have a large number of blood samples that they can study to try and find biomarkers, other than CA 125, for ovarian cancer.

Recently, doctors think that most high grade serous ovarian cancers actually start in cells at the far end of the fallopian tube. These early cancer cells then spread to the ovary and grow. Researchers hope to develop screening tests that can pick up these very early cancer cells.

BRCA 1 and 2 and other genes

We can now test for 3 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. Another gene fault that increases risk of ovarian cancer is called HNPCC (hereditary non polyposis colorectal cancer), also called Lynch syndrome.

Cancer Research UK funded scientists have recently discovered that faults in the RAD51D gene can also increase the risk of developing ovarian cancer. Testing for this gene fault in the future may be helpful for women with a family history of the disease. The researchers hope this discovery may also lead to the development of new treatments.

There is information about gene faults and ovarian cancer in our section about genes and inherited cancer risk. It is important to remember that most cancers happen because of damage to cells that occurs during our lives, not because we have inherited any specific gene fault. But the Familial Ovarian Cancer Registry trial found that in families where at least 2 relatives have (or have had) ovarian cancer, there were faults in the BRCA1 or BRCA2 genes. 

This information is helping women to make difficult decisions about preventing 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.

Researchers want to find out more about the causes of ovarian cancer, including the part that faulty genes play. There is also research looking into treatment for ovarian cancers with BRCA1 or BRCA2 gene faults, for example PARP inhibitors. There is information about trials for women with faulty BRCA1 or BRCA2 genes on our clinical trials database. Choose 'ovarian cancer' from the dropdown list of cancer types.

Fluid and ovarian tissue samples

There is a study looking at substances called metabolites. Researchers are studying tissue and body fluid samples of women with and without ovarian cancer. They use a technique called metabonomics, which looks at the substances used or produced by any set of chemical reactions in the body (metabolites). Metabonomics may one day help doctors diagnose, monitor and treat ovarian cancer more easily.

HRT and ovarian cancer risk

Women who use HRT have an increased risk 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 2,500 women who take HRT. And for every 3,300 women who take HRT, one more will die than in 3,300 women who do not take HRT. When women stop taking HRT, their risk of developing ovarian cancer goes down to average after a few years.

The pill and ovarian cancer risk

Taking the pill is known to lower the risk of ovarian cancer for the average woman. But we don't know if the pill can lower risk for women who carry a gene that increases their ovarian cancer 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 similar drugs, 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 any drug to stop your blood clotting, such as warfarin, heparin or coumadin.

 

Research into borderline ovarian tumours

Borderline ovarian tumours are not considered to be true cancers. They are made up of abnormal cells that may become cancer. They develop in the ovary but do not usually grow into surrounding tissue and rarely spread. Doctors and researchers want to find out more about how these tumours develop. They will gather information from samples of tumour tissue. They will also look at what treatment women have and will collect data from follow up visits. They hope this information will help them to be able to shape treatments to better suit individual women in the future.

You can find out about this borderline ovarian cancer trial on our clinical trials database.

 

Chemotherapy research for ovarian cancer

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

Chemotherapy before surgery

Doctors are looking at giving chemotherapy before surgery in ovarian cancer. This is called neo adjuvant chemotherapy. A large randomised trial (EORTC 55971) showed that 3 cycles of chemotherapy before surgery was as good as having surgery first (and then chemotherapy) for women with stage 3c and 4 ovarian cancer. Results from the CHORUS trial were presented at a large cancer conference in America in 2013. They showed that the survival rates were similar for women with stage 3 and 4 ovarian cancer having neo adjuvant chemotherapy compared to women having surgery followed by chemotherapy. 

Doctors are starting to use neo adjuvant chemotherapy more often for some women with stage 3 or 4 disease.

Different doses and combinations of drugs

Some trials look at better ways of giving treatment.  This may be changing the dose, or adding another drug to treatment that we already use.  Most women with cancer of the ovary will have chemotherapy that includes the drug carboplatin. The ICON 8 trial is looking at whether lower doses of weekly carboplatin and paclitaxel are better than the standard 3 weekly chemotherapy.

Other trials have looked at combining different drugs with carboplatin. There are trials that have looked at adding gemcitabine to the standard combination of paclitaxel and carboplatin. Researchers for the Neo-ESCAPE trial have suggested that it may be helpful to give carboplatin before surgery followed by paclitaxel and gemcitabine for women with advanced ovarian, fallopian tube or peritoneal cancer.

One trial is looking at a drug called PEG-Irinotecan (NKTR-102) for advanced ovarian cancer when platinum drugs have not worked.

Trabectedin (Yondelis) is a type of chemotherapy drug. A study in 2010 showed that the combination of trabectedin and liposomal doxorubicin was better than liposomal doxorubicin alone. The average length of time women lived without the cancer getting worse (progression free survival) was 7.3 months for women taking the combination of drugs, and 5.8 months for those having liposomal doxorubicin alone. Trabectedin is now licensed to treat ovarian cancer that has come back (relapsed) along with liposomal doxorubicin. But the National Institute of Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) have not recommended this drug for use within the NHS for relapsed ovarian cancer. 

Sometimes trials look at particular sub types of cancers.  This is because doctors suspect that a rarer type of cancer may not respond as well to the standard treatment for the more common type. The CCC1 trial is comparing paclitaxel and carboplatin with irinotecan and cisplatin for clear cell cancer, a rare sub type of epithelial ovarian cancer. Doctors hope that a combination of irinotecan and cisplatin will work better than the standard ovarian cancer treatment.

There are also trials adding biological therapies to chemotherapy. There is more about this further down this page, under the heading Biological therapies.

Preventing resistance to chemotherapy

Carboplatin and paclitaxel are drugs that many women have when they are first diagnosed with ovarian cancer. If they work well for you, doctors may suggest having them again if your cancer comes back. But unfortunately, ovarian cancer can stop responding to these chemotherapy drugs. This is called resistance to treatment. There is research looking into overcoming treatment resistance in many cancers, including cancer of the ovary.

One recent study found that blocking certain proteins such as TGFBI made ovarian cancer cells more sensitive to paclitaxel. The researchers hope this finding may lead to the development of new drugs which may help paclitaxel work better.

The aim of the BriTROC 1 study is to help understand why ovarian cancer can come back or continue to grow after chemotherapy. The researchers are collecting samples from women with ovarian cancer, fallopian tube cancer and primary peritoneal cancer. They will look at differences between tumours that come back after chemotherapy compared to when they were first diagnosed. This may help doctors understand why tumours stop responding to chemotherapy. They may also find ways of predicting which tumours will respond to chemotherapy.

Chemotherapy into your abdomen

This is called intra peritoneal 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.

Radioactive liquid into the abdomen

The idea of this type of treatment is that the chemotherapy reaches cancer cells in your abdomen in a higher concentration than it would through the bloodstream. Research has been going on for many years into intra peritoneal chemotherapy and continues to be an area of active study. 

Some trials have shown that it may be useful, but any advantages have to be weighed up against the demands of having the treatment, and the side effects. A review in 2011 of all the studies that looked at intra peritoneal chemotherapy (IP) compared to chemotherapy through a drip into a vein found that IP chemotherapy helped some women with advanced ovarian cancer to live longer. But giving chemotherapy in this way also causes side effects, such as pain in the abdomen, blockage of the tube used to give the chemotherapy, digestive problems and infection. You can find the review on the Cochrane Library website

If your doctor suggests this type of treatment, it is most likely to be as part of a clinical trial. The PETROC/OV21 trial is comparing 3 different types of chemotherapy for women who have already had chemotherapy followed by surgery for ovarian cancer. In this study, researchers are looking at giving different chemotherapy drugs in different ways after surgery. In 2 of the groups women have intra peritoneal chemotherapy as well as chemotherapy into a vein. One group has intra peritoneal cisplatin and one group has intra peritoneal paclitaxel. 

The aim of the study is to find out if chemotherapy into the abdomen helps women with ovarian cancer and which type of chemotherapy is best. 

Finding out who chemo will work best for

Some women with ovarian cancer respond better to chemotherapy than others. Doctors hope to be able to predict which women chemotherapy will work for. There is research looking into patterns in DNA in cancer cells. The researchers hope to find patterns that will help them tell in advance whose cancer will respond to chemo and whose won't. This will help stop people having to put up with side effects from treatment that is not suitable for them. They could then be offered a different type of treatment. 

The CTCR-OV03 study combined information about DNA in cancer cells with blood samples and results of MRI scans. They recruited 28 women onto the trial. The researchers found that it might be possible to use different types of MRI scans to find out in advance how well chemotherapy would work for ovarian cancer. 

The OXO PCR 01 study is looking at cancer samples, blood samples and scans to see how and why women with ovarian cancer do or don't respond to paclitaxel chemotherapy. Researchers hope to develop a way of working out in the future which women are suitable for this treatment, and to develop new treatments for ovarian cancer.

There is more information about these chemotherapy trials on our clinical trials database. Choose 'ovarian' from the dropdown list of cancer types.

 

Biological therapies

Biological therapies are treatments that can control the growth of cancer cells. There are many different types. There is information here about

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. There are other types of kinase inhibitor too.

The SaPPrOC trial is looking at whether adding a kinase inhibitor drug called saracatinib to paclitaxel can help women who have ovarian, fallopian tube or primary peritoneal cancer that has come back. Saracatinib is also known as AZD 0530. This trial has now closed and we are waiting for the results.

Another trial is looking at a new drug called MK-1775 with chemotherapy for ovarian cancer that has come back. The women in this trial have tumours with a particular change (mutation) to a gene called p53. The p53 gene is involved in controlling how cells divide and grow. The women taking part also have cancer that has responded to treatment with platinum chemotherapy drugs in the past (platinum sensitive ovarian cancer). The researchers want to see if adding MK-1775 to paclitaxel and carboplatin chemotherapy helps this group of women, and to learn more about the side effects. This trial has now closed and we are waiting for the results.

Blood supply blockers

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.

Ovarian cancer trials have looked at

Bevacizumab (Avastin)

Bevacizumab (Avastin) has been looked at in major phase 3 trials. The American GOG218 trial reported in June 2010 that bevacizumab with chemotherapy controlled advanced ovarian cancer for longer than chemotherapy alone. All the women in the trial had standard chemotherapy. Half of the women also had bevacizumab during the chemotherapy and then on its own once the chemotherapy had ended. Another large American trial reported in December 2011 and confirmed that adding bevacizumab to standard chemotherapy seems to control advanced ovarian cancer for about 4 months longer than chemotherapy alone.

In the UK a large, phase 3 trial called ICON 7 looked into whether adding bevacizumab to standard chemotherapy could lower the risk of ovarian cancer coming back after surgery. Between December 2006 and February 2009, 1528 women from Europe, Canada, Australia and New Zealand joined the trial. They had all had ovarian cancer removed with surgery. Half the women had standard chemotherapy with carboplatin (Paraplatin) and paclitaxel (Taxol)l every 3 weeks for 6 cycles of treatment and then no treatment until their cancer started to grow again. The other women had bevacizumab as well as the standard chemotherapy. When their chemotherapy finished they had 12 more doses of the bevacizumab every 3 weeks.

The research team found that combining bevacizumab with standard chemotherapy lengthened the time before the cancer came back for some women. But it didn't help the women live longer. Overall, women who had bevacizumab and chemotherapy had an average of 2 months of extra time without the cancer coming back or growing. Women who had a more advanced stage cancer to start with had the most benefit. Women in both treatment groups had some side effects. The most common side effect of bevacizumab was high blood pressure but this was easily treated.

Early in 2012 bevacizumab was licensed within Europe for advanced ovarian cancer as a first treatment to have along with chemotherapy. This treatment has not been approved by the National Institute of Health and Care Excellence (NICE) or the Scottish Medicines Consortium (SMC) as a first treatment within the NHS. In England, doctors may be able to access this drug through the cancer drugs fund

The mEOC trial is comparing 2 different chemotherapy combinations with or without bevacizumab for a rare sub type of ovarian cancer called mucinous epithelial ovarian cancer. The doctors in this trial want to find out which chemotherapy combination works better to control cancer growth. And they want to find out whether adding bevacizumab to chemotherapy is a useful treatment for this group of women.

Cediranib (Recentin)

Another drug which disrupts the tumour's blood supply is called cediranib (also known as Recentin or AZD2171). It is taken as a tablet. A large trial called ICON6 looked at whether adding cediranib to standard chemotherapy can work better for ovarian cancer that comes back after initial treatment. The Cancer Research UK funded trial reported in November 2013. When ovarian cancer comes back and is treated with standard platinum based chemotherapy it normally takes 8 to 9 months before the cancer starts to grow again. But adding cediranib increased the time to more than 12 months. The trial also found that women who had cediranib lived on average 3 months longer than women who only had standard chemotherapy. You can read the full results of the ICON6 trial on our clinical trials database.

Other anti angiogenic drugs

Several other drugs that affect cancer blood supply are being researched, including drugs called combretastatin, BIBF 1120 and DMXAA (or AS 1404). All these are quite early trials. BIBF 1120 showed in a small trial that it could help stop some ovarian cancers growing. A larger trial is planned. If combretastatin and DMXAA show promise when the trial results are available, they may go on to be tested in larger trials, comparing them to standard treatments.

Trebananib (AMG 386) is another type of anti angiogenic drug being looked at in trials alongside chemotherapy. Early phase trials have shown promising results and so is now being looked at in phase 3 trials for ovarian cancer.

Tasquinimod also works by blocking the growth of new blood vessels to the cancer and by helping the body's immune system. A trial is looking at tasquinimod for advanced cancer of the liver, ovary, kidney or stomach.

Monoclonal antibodies

Monoclonal antibodies are designed to recognise and find specific abnormal proteins on cancer cells. Each monoclonal antibody recognises one particular protein. There is a trial using a new monoclonal antibody called farletuzumab alongside chemotherapy for ovarian cancer that has come back after initially responding to platinum chemotherapy. The trial aims to see if farletuzumab and chemotherapy works better than chemotherapy alone for ovarian cancer that has come back. It also wants to find out which is the best dose of farletuzumab and learn more about its side effects.

PARP-1 inhibitors

PARP inhibitors are drugs that block a protein in cells, called PARP. This protein is important for cells to repair their DNA, particularly in cells that have BRCA1 or BRCA2 gene faults. So if researchers can block this protein, they hope that cancer cells won't be able to repair themselves and will die. The first research with these drugs has been in people with cancers that have these particular gene faults. But researchers are also looking into using these drugs to treat cancers that don't have the BRCA gene mutations.

A trial is testing a PARP inhibitor called rucaparib (AG-014699) in women with stage 3 or 4 ovarian cancer with BRCA1 and 2 gene faults. The ARIEL2 study is looking at rucaparib for ovarian cancer that has come back after chemotherapy.

There have been several trials with a PARP inhibitor called olaparib (or AZD 2281). This has been tested in advanced ovarian cancer alongside chemotherapy and after chemotherapy.  Most of the research has been with women whose ovarian cancer has a BRCA1 or 2 gene fault. But there has also been some research looking at how well this drug works in women without these gene faults. There have been some promising early trial results but we still need results from large, longer term trials to find out exactly how helpful olaparib is in treating ovarian cancer. We have more information about olaparib in our question and answer section.

Vaccines

TroVax is a type of vaccine that helps the immune system to recognise and attack cancer cells. After treatment for ovarian cancer, primary peritoneal cancer or fallopian tube cancer, you may have blood tests to look for a tumour marker called CA125. Having an increased amount of CA125 in your blood may mean that your cancer has come back. If you have a raised CA125 level without any signs or symptoms of your cancer having come back, your doctor may not want you to start chemotherapy straight away. The aim of the TRIOC trial is to find out if giving TroVax after a rise in CA125 can slow the growth of cancer and delay the start of chemotherapy.

There is information about these trials on our clinical trials database. Choose 'ovarian' from the dropdown list of cancer types.

 

Surgery

The DESKTOP 3 trial is looking at surgery for ovarian cancer that has come back (relapsed). Doctors usually treat ovarian cancer that has come back with chemotherapy alone. In this trial, doctors want to find out if it is better to have surgery and chemotherapy.

 

Hormone treatment

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.

Some small studies have shown that another hormone therapy called letrozole can stop the growth of ovarian cancer for some time in women with ovarian cancers that have oestrogen receptors. We need larger studies to find out how helpful letrozole is compared to standard treatments already being used for ovarian cancer that has come back.

Anastrozole is another type of hormone therapy that doctors use to treat breast cancer. Researchers are now looking to see if it helps women with other types of hormone sensitive cancers. The PARAGON trial is looking at anastrozole for gynaecological cancer that has come back after chemotherapy. The women taking part are post menopausal and have a hormone receptor positive cancer.

 

Tests to see how treatment is working

During chemotherapy you often have a CT scan after a few treatments to see how well it is working. Researchers are trying to find ways of picking up more quickly whether treatment is working for women who have ovarian cancer that has come back. One small phase 1 study is looking to see if PET-CT scans are better than CT scans alone.

There is a trial looking at using the CA125 test during treatment for advanced ovarian cancer. This will help doctors to know whether you are having the right treatment. All treatments have side effects and it is important that women don't have to put up with side effects from a treatment that is not helping them. 

You can find out more about treatment trials for ovarian cancer on our clinical trials database. Go to the advanced search and choose 'ovarian' from the dropdown menu of cancer types and 'treatment' from the list of trial types. If you want to see all the trials, tick the boxes for closed trials and trial results.

 

Fertility drugs

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.

 

Helping with bowel problems after radiotherapy

The HOT II 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 area between the hips (the pelvic area). Most side effects will get better a few months after treatment has finished. But for a small number of people there can be long lasting bowel side effects, including frequent bowel movements, diarrhoea, pain, bleeding from the bowel and the forming of scar tissue (radiation fibrosis).

There is information about trials for ovarian cancer on our clinical trials database. Choose 'ovarian' from the dropdown list of cancer types. If you want to see all the trials, tick the boxes for closed trials and trial results.

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Updated: 8 May 2014