Chemotherapy in epithelial ovarian cancer. Dr.Azarm
Recommendation — platinum agents (especially carboplatin) plus paclitaxel, carboplatin plus paclitaxel is the standard of care for EOC The regimen I use is paclitaxel 175 mg/m2 over three hours plus carboplatin AUC 6 to 7.5 (starting with the higher dose), every three weeks for sixcarboplatinpaclitaxel
Taxanes plus platinum agents: The regimen of paclitaxel (135 mg/m2 over 24 hours) immediately followed by cisplatin (75 mg/m2) offers the best therapeutic ratio, and initial studies ameliorated concerns for overlapping neurotoxicitycisplatin Dr.Azarm
Carboplatin plus docetaxel: Docetaxel may represent Docetaxel a less toxic alternative to paclitaxel. paclitaxel Dr.Azarm
Recommendation : Based upon the favorable safety profile of platinum agents (especially carboplatin) plus paclitaxel.carboplatinpaclitaxel The regimen doses are paclitaxel 175 mg/m2 over three hours plus carboplatin AUC 6 to 7.5 (starting with the higher dose), every three weeks for six cycles. For women with advanced disease (stage III and IV with either small volume of large volume disease), response rates approach 90 percent, with 75 percent achieving a clinical complete response.
Maintenance therapy : -Focused upon extending the duration of induction chemotherapy -Prolonged administration of single agents Chemotherapy -IP chemotherapy, -Hormonal agents, -Immunotherapy. None of these strategies has been shown to improve outcomes
Intraperitoneal chemotherapy : IP therapy can permit a several-fold increase in drug concentration in the abdominal cavity compared to systemic administration. IP cisplatin IP paclitaxel IP chemotherapy is benefit in a subset of women with optimally cytoreduced EOC (to <0.5 cm), IP chemotherapy should not be considered standard therapy, and used only in the context of a clinical trial.
Stem cell-supported high dose chemotherapy - Response rates are initially high, but short lived (usually six to nine months) - There is no convincing evidence of a long-term survival benefit - Women undergoing transplant with platinum- resistant bulky disease do particularly poorly prognosis.
NEOADJUVANT CHEMOTHERAPY VERSUS INITIAL SURGICAL DEBULKING: Primary surgical cytoreduction followed by systemic chemotherapy is the preferred initial management for women with stage III or IV EOC.
CONCLUSIONS AND RECOMMENDATIONS : The combination of a platinum (usually carboplatin) and paclitaxel is standard therapy for the first-line treatment of women with EOC who require systemic chemotherapy. carboplatin For women with advanced disease (stage III and IV with either small volume of large volume disease), response rates approach 90 percent, with 75 percent achieving a clinical complete response.
All women with nondysgerminomatous germ cell malignancies, except those with unruptured stage IA disease, grade 1 immature teratomas should receive postoperative adjuvant chemotherapy.
Patients with stage II or III disease )GST) who have a complete tumor resection and adjuvant chemotherapy will almost always remain free of recurrence.
VAC (vincristine, actinomycin-D, and cyclophosphamide)vincristinecyclophosphamide PVB (cisplatin, vinblastine, and bleomycin)cisplatinvinblastinebleomycin both had good activity against the various germ cell malignancies. Choice of regimen in GST of Ovary :
Management of immature teratomas Several reports support the successful management of these patients with surgery alone.
MANAGEMENT OF ADVANCED DISEASE Patients with incompletely resected metastatic ovarian GCTs should receive cisplatin-based combination chemotherapy.
PEB cisplatin 20 mg/m2 days one through 5 days, etoposide 100 mg/m2 days one through five, cisplatin both every 21 days, bleomycin 30 units weekly) bleomycin for three to four courses has become the standard regimen for patients with advanced ovarian GCT, and long- term survival can be expected in 60 to 80 percent of cases.
Etoposide (120 mg/m2 on days 1 through 3), Carboplatin (600 mg/m2 on day 2), and Bleomycinleomycin (15 mg/m2 on day 3 ), with courses administered every 3 to 4 weeks until remission, and then two more courses. With a median follow-up of 53 months, the five-year survival and event-free survival rates were 91 and 88 percent,
Cisplatin-based chemotherapy is highly effective for advanced (incompletely resected or recurrent) dysgerminoma ysgerminoma: d
LATE EFFECTS OF TREATMENT : -renal and gonadal dysfunction, -neurotoxicity, -cardiovascular toxicity, and -secondary malignancies