Ovarian germ cell tumor medical therapy

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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

• 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. The platinum-based regimen is currently the most effective management.

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.
• 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.
• There is no pharmacologic therapy for the mature teratoma.

Stage I ovarian germ cell tumors

• Dysgerminomas

• Unilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy

• Other germ cell tumors

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

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