The Basics
After therapy is completed, when there is no evidence of disease or sometimes when 
there is still some disease left, patients may choose observation or maintenance. Observation is exactly what the name implies: there is no cancer treatment but patients are monitored to determine if the cancer has returned.
Maintenance is designed to prolong remission and lower the risk of cancer recurrence. It can also be used when there is still cancer present to prevent it from growing. Patients may take maintenance therapies for months or even years. PARP inhibitors are the newest drugs to be shown helpful in these situations.
Maintenance Treatments After First-line Chemotherapy
These tables list the drugs most commonly used for maintenance after first-line treatment. These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as preferred treatment options. Please take this information to your doctor as an aid for your discussions.
PARP (Poly ADP-ribose polymerase) inhibitors, olaparib (Lynparza) and niraparib (Zejula) were recently approved as maintenance therapy following first line treatment based on their effectiveness in preventing recurrence. People with BRCA1 or 2 gene mutations detected in their blood (germline; hereditary) or tumor (somatic) received the most benefit from such treatment. Therefore, genetic testing for inherited cancer risk can be important – even if there is no family history. If negative, tumor testing can be performed to determine if a BRCA mutation is found only in the tumor (called “somatic”).
One additional biomarker is called HRD (homologous recombination deficiency). HRD testing provides an estimate of the “BRCAness” characteristic of the tumor by measuring the genomic instability that results from problems with DNA damage repair. This increased damage occurs in tumors that do not have a functional BRCA protein (e.g., due to a mutated BRCA gene). It also sometimes occurs when the BRCA gene is not mutated but other genes in the DNA damage repair pathway are altered. In those cases the HRD test is positive. Studies show that people whose tumors are HRD positive may have more benefit from PARP inhibitor treatment than those whose tumors are HRD negative (also called HRP for homologous recombination proficient).
There are other treatments being evaluated in clinical trials for maintenance treatment after first-line therapy. Visit the clinical trials page and scroll down to find them.
Maintenance Treatments After Recurrence
This table lists the drugs most commonly used when cancer returns more than 6 months after the last platinum treatment and then responds again to platinum-based chemotherapy. These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as preferred treatment options. Treatment with these drugs generally starts about eight weeks after completing chemo. Please take this information to your doctor as an aid for your discussions.
PARP (Poly ADP-ribose polymerase) inhibitors, olaparib (Lynparza) and niraparib (Zejula) were recently approved as maintenance therapy following first line treatment based on their effectiveness in preventing recurrence. People with BRCA1 or 2 gene mutations detected in their blood (germline; hereditary) or tumor (somatic) received the most benefit from such treatment. Therefore, genetic testing for inherited cancer risk can be important – even if there is no family history. If negative, tumor testing can be performed to determine if a BRCA mutation is found only in the tumor (called “somatic”).
One additional biomarker is called HRD (homologous recombination deficiency). HRD testing provides an estimate of the “BRCAness” characteristic of the tumor by measuring the genomic instability that results from problems with DNA damage repair. This increased damage occurs in tumors that do not have a functional BRCA protein (e.g., due to a mutated BRCA gene). It also sometimes occurs when the BRCA gene is not mutated but other genes in the DNA damage repair pathway are altered. In those cases the HRD test is positive. Studies show that people whose tumors are HRD positive may have more benefit from PARP inhibitor treatment than those whose tumors are HRD negative (also called HRP for homologous recombination proficient).
There are other treatments being evaluated in clinical trials for maintenance after treatment for recurrence. Visit the clinical trials page and scroll down to find them.