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

• The mainstay of therapy for ovarian germ cell tumor is surgery. However, chemotherapy is indicated in those with malignant germ cell tumor with stage 1b or more advance stage except for those mentioned earlier.
• 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