Systemic therapy for gynecologic cancer

Over the past year, a number of important papers have appeared in the medical literature dealing with the chemotherapeutic management of gynecologic cancers. Among these papers, several studies have again demonstrated the superiority of platinum-based chemotherapy regimens for ovarian cancer compared with non-platinum-containing regimens, and have confirmed the equivalence of carboplatin to cisplatin in advanced disease. A number of trials have reported activity for intraperitoneal chemotherapy regimens in patients with small-volume residual disease. In endometrial cancer, combination cisplatin-based chemotherapy programs have been reported to achieve an overall 40% to 50% objective response rate. Although induction chemotherapy has been advocated in the management of advanced localized cervical cancer, this conclusion has yet to be supported by the results of randomized trials. The etoposide, methotrexate, dactinomycin, cyclophosphamide, vincristine regimen has been demonstrated to be highly effective in patients with high-risk gestational trophoblastic tumors. Finally, a recent report has demonstrated that it is possible to perform conservative surgery in patients with germ cell tumors to preserve fertility without compromising therapeutic efficacy.