Ovarian germ cell tumor medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==
*Chemotherapy is recommended among patients diagnosed with stage 1b or more advanced stages of dysgerminoma and is not recommended for those with stage 1a for whom surgical intervention is curative.
* Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas.<ref> "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer. National comprehensive cancer network, 2011; http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf."</ref>
*In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.
* In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.
* In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.
* Platinum-based regimen is currently the most effective management.
** This regimen is as following:
*** [[Bleomycin]] 30 Unit IV per dose be given on day 1, 8, and 15 of the cycle
**** It must be diluted in  50 ml of normal saline (NS) and over 10 minutes.
*** [[Etoposide]] 100 mg/m2 IV per day be given on days 1-5.
**** It must be diluted in 500 ml NS (concentration less than 0.4 mg/mL) and administered over one hour.
*** [[Cisplatin]] 20 mg/m2 IV per day be given on Days 1 through 5.
**** It must be diluted in 250 mL NS and administer over two hours.
**** No aluminum needles or intravenous sets be used for the administration.
** This regimen is given every 21 days for three cycles (or four cycles in the presence of bulky residual disease after surgery.
** Factors that should be monitored during the treatment:
***Complete blood count (CBC) weekly during treatment
***Liver function test (LFT) before each treatment cycle
***Creatinin and electrolytes before each treatment cycle
***Pulmonary function test before starting bleomycin and at repeated intervals


*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Dysgerminoma===
* '''Stage 1 dysgerminoma'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
The mainstay of therapy for ovarian germ cell tumor is [[chemotherapy]].<ref name= cba> Stage I Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name= sss> Stage II Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015</ref><ref name= www> Stage III Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name= rrr> Stage IV Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
==Medical Therapy==
==Medical Therapy==
*The mainstay of therapy for ovarian germ cell tumor is [[chemotherapy]].<ref name= cba> Stage I Ovarian Germ Cell Tumors
*The mainstay of therapy for ovarian germ cell tumor is [[chemotherapy]].<ref name= cba> Stage I Ovarian Germ Cell Tumors

Revision as of 18:22, 12 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

  • Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas.[1]
  • In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.
  • In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.
  • Platinum-based regimen is currently the most effective management.
    • This regimen is as following:
      • Bleomycin 30 Unit IV per dose be given on day 1, 8, and 15 of the cycle
        • It must be diluted in 50 ml of normal saline (NS) and over 10 minutes.
      • Etoposide 100 mg/m2 IV per day be given on days 1-5.
        • It must be diluted in 500 ml NS (concentration less than 0.4 mg/mL) and administered over one hour.
      • Cisplatin 20 mg/m2 IV per day be given on Days 1 through 5.
        • It must be diluted in 250 mL NS and administer over two hours.
        • No aluminum needles or intravenous sets be used for the administration.
    • This regimen is given every 21 days for three cycles (or four cycles in the presence of bulky residual disease after surgery.
    • Factors that should be monitored during the treatment:
      • Complete blood count (CBC) weekly during treatment
      • Liver function test (LFT) before each treatment cycle
      • Creatinin and electrolytes before each treatment cycle
      • Pulmonary function test before starting bleomycin and at repeated intervals

Medical Therapy

  • The mainstay of therapy for ovarian germ cell tumor is chemotherapy.[2][3][4][5]
  • There is no pharmacologic therapy for the mature teratoma.

Stage I ovarian germ cell tumors

  • Dysgerminomas
  • Other germ cell tumors

Stage II ovarian germ cell tumors

  • Dysgerminomas
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy
  • Other germ cell tumors
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy

Stage III ovarian germ cell tumors

  • Dysgerminomas
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy
  • Other germ cell tumors
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy

Stage IV ovarian germ cell tumors

  • Dysgerminomas
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy
  • Other germ cell tumors
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy

References

  1. ↑ "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer. National comprehensive cancer network, 2011; http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf."
  2. ↑ Stage I Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015
  3. ↑ Stage II Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015
  4. ↑ Stage III Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015
  5. ↑ Stage IV Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015

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