Cytotoxic chemotherapy for gynaecologic malignancies

Cytotoxic chemotherapy is assuming an increasingly important role in the management of gynaecologic tumours both in an adjuvant setting and as therapy for clinical disease as well as for palliation. Choriocarcinoma and germ cell tumours of the ovary which in the prechemotherapy era were nearly always fatal, are now among the most curable of all cancers; significant prolongation and improvement in quality of life for those with epithelial ovarian carcinomas and uterine malignancies is now possible. Clinical pharmacological principles in gynaecological anticancer chemotherapy, such as those concerned with selection of appropriate agents, factors in the decision to treat, response evaluation and the rationale for combination chemotherapy are discussed. Combination regimens exploit understanding of cellular genetics, different biochemical mechanisms of drug action and differing toxicity profiles both to minimise emergence of drug resistance and to obtain enhanced efficacy. Common and frequent toxic effects encountered with chemotherapeutic agents used in gynaecologic oncology chemotherapy are presented and their management, which includes strategies to minimise occurrence or reduce their severity is outlined.