Future directions in gynecologic cancer

Cisplatin is one of the most commonly used chemotherapeutic agents to treat gynecologic cancers. However, many patients treated with platinum therapy experience significant toxicities, including neurotoxicity, ototoxicity, and/or nephrotoxicity. Clinical trials have documented the role of amifostine as a cytoprotectant against cisplatin-induced toxicities in patients with advanced ovarian cancer. In these trials, the incidence and severity of many dose-limiting toxicities was reduced significantly by the concomitant administration of amifostine. The management of advanced ovarian, cervical, and endometrial cancers provides many opportunities for future applications of amifostine. Several studies that are being initiated in the United States involve maintaining platinum dose intensity, reducing toxicities, and developing chemotherapeutic combinations that would otherwise have to be avoided without the use of a cytoprotective agent such as amifostine.