What targeted therapies are available for Ovarian Cancer

Targeted Therapies for Ovarian Cancer

Targeted therapies are medications designed to attack specific characteristics of cancer cells, rather than broadly killing all rapidly dividing cells like traditional chemotherapy does. For ovarian cancer, several targeted therapy options exist, and your oncologist will determine which is appropriate based on your specific tumor characteristics.

Key Targeted Therapy Categories

PARP Inhibitors (Poly-ADP-Ribose Polymerase Inhibitors)

PARP inhibitors are among the most important targeted therapies for ovarian cancer. These drugs work by blocking a protein that helps cancer cells repair DNA damage.

Who benefits most: Patients with BRCA1/2 mutations or HRD (homologous recombination deficiency)

Available PARP inhibitors include:

• Olaparib (FDA-approved for BRCA-mutated ovarian cancer)
• Niraparib (approved for platinum-sensitive recurrent disease)
• Rucaparib (approved for BRCA-mutated disease)

According to NCCN Guidelines, PARP inhibitors can be used as maintenance therapy (continuing treatment after chemotherapy response) or for recurrent disease, particularly in patients who have completed two or more lines of platinum-based chemotherapy.

Bevacizumab (Anti-Angiogenesis Therapy)

Bevacizumab works by blocking blood vessel formation, which starves tumors of nutrients they need to grow.

How it's used:

• Combined with chemotherapy for platinum-resistant recurrent ovarian cancer
• As maintenance therapy after chemotherapy response
• The AURELIA trial (referenced in NCCN Guidelines) demonstrated improved outcomes when bevacizumab was combined with chemotherapy in platinum-resistant disease

Folate Receptor Alpha (FRα) Targeted Therapy

Mirvetuximab soravtansine is an antibody-drug conjugate (a targeted therapy that delivers chemotherapy directly to cancer cells expressing folate receptor alpha).

According to NCCN Guidelines:

• Category 1 recommendation (highest level of evidence) for patients with FRα-expressing tumors (≥75% positive tumor cells) with platinum-resistant disease
• Can be combined with bevacizumab for certain patients

Immunotherapy Options

For specific molecular subtypes:

• Dostarlimab - for dMMR/MSI-H (mismatch repair deficient/microsatellite instability-high) recurrent or advanced ovarian cancer
• Pembrolizumab - for MSI-H or dMMR tumors, or TMB-H (tumor mutational burden-high) tumors

Mutation-Specific Targeted Therapies

For less common ovarian cancer subtypes:

• BRAF V600E mutations: Dabrafenib + trametinib
• NTRK gene fusions: Entrectinib, larotrectinib, or repotrectinib
• RET gene fusions: Selpercatinib
• Low-grade serous carcinoma with KRAS mutations: Avutometinib/defactinib or trametinib

How Molecular Testing Guides Treatment

According to NCCN Guidelines, validated molecular testing should be performed in a CLIA-approved facility and should include testing for:

• BRCA1/2 mutations
• HRD (homologous recombination deficiency) status
• MSI/MMR (mismatch repair) status
• TMB (tumor mutational burden)
• BRAF, FRα (FOLR1), RET, and NTRK mutations
• HER2 status

This comprehensive testing helps identify which targeted therapies may be most effective for your specific cancer.

Important Questions to Ask Your Oncologist

1. Has my tumor been tested for BRCA mutations and HRD status? If not, should it be?
2. Based on my tumor's molecular characteristics, which targeted therapies are options for me?
3. Am I eligible for PARP inhibitor therapy, and if so, when would it be recommended?
4. Has my tumor been tested for other mutations (BRAF, NTRK, RET, FRα expression)?
5. What are the side effects of the targeted therapy you're recommending, and how are they managed?
6. Are there clinical trials available for targeted therapies I might be eligible for?

Key Takeaway

Targeted therapies have transformed ovarian cancer treatment, particularly for recurrent disease. The specific therapy recommended for you depends on your tumor's molecular profile, disease stage, prior treatments, and overall health. Your oncologist will determine the most appropriate approach based on your complete clinical picture and the latest evidence.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.

Sources: NCCN Guidelines Version 3.2025 for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer