Question asked by: 
Lorraine
Date asked: 
Mar 2015

What treatment options are available for third line treatment for low grade ovarian cancer? I have low grade disease and so far I had single agent Carboplatin (2011) for first line and Carboplatin and Gemcitabine with Avastin for second line (2014). During first line my CA125 levelled out after four treatments and I had a partial response during second line.

What treatment options are available for third line treatment for low grade ovarian cancer?
The treatment we give second/third/fourth etc line depends on several things.
Response by Professor Iain McNeish, Professor of Gynaecological Oncology

This is a very interesting question. The treatment we give second/third/fourth etc line depends on several things:

  1. How long it has been since previous treatment
  2. Type of ovarian cancer
  3. Trials that we have available at that time.

The caveat to the answer below is that I have never met you, so my comments are general rather than specific to your case. It is also not clear from your question whether you are still receiving Avastin. 

For a low grade serous tumour, we often try hormone therapy if the original tumour stained strongly for ER (Estrogen Receptor) and, to a lesser extent, PR (Progesterone receptor). If it did, I would start with letrozole, but anastrazole and tamoxifen may be equally good (there has never been a direct comparison). 

We have had patients on these for many months and sometime years. There will also be a new trial opening in some centres in the UK within a few months - called LOGS. It's the first UK study specifically in low grade serous ovarian cancer and we are really keen for patients to take part when it opens. In the trial, patients will receive a novel drug called trametinib - half the patients receive it immediately and half following treatment with chemotherapy or hormone therapy.

The other thing to say is that, if the patient is asymptomatic and feeling well, we often sit tight for a while.