Gynecologic malignancies

Several general conclusions are beginning to emerge from the series of prospective trials in the treatment of ovarian cancer. Combination chemotherapy continues to demonstrate higher overall response rates and higher complete remission rates than single alkylating agents, although in some studies survival is not significantly different. Nevertheless, long-term disease-free survivals, although uncommon, are more frequent with combinations, particularly when the dose intensity of the combination is adequate. Although CAP is the most commonly used combination, evidence continues to suggest that cyclophosphamide/cisplatin alone may be equivalent. Several studies have incorporated alkylating agent maintenance into their clinical trials and each reports acute leukemic complications. In light of the absence of a major contribution for this approach, alkylating agent maintenance in ovarian cancer should not be encouraged. Several studies this year emphasize the discouraging results associated with the use of total abdominal radiation therapy post-induction chemotherapy even with patients with minimal or no residual disease. In light of the publications this year and of previously published studies, this approach, although based on sound rationale, appears to be of limited benefit. Salvage chemotherapy, in general, has been unsatisfactory. The 2 interesting reports this year were the activity of low-dose mitomycin C and the potential utility of VP-16/cisplatin combinations in a salvage setting. In cervix carcinoma, trials have documented significant activity for the new drugs, carboplatin (28% response) and ifosfamide (30%), but each has significant side effects. Whether these will prove more active than cisplatin or whether they may be used in combination is unresolved. The continued investigation into the use of radiation sensitizers in cervical carcinoma is of interest and several studies using weekly low-dose cisplatin have established the feasibility of this approach, although long-term survival benefits have not yet been documented. In endometrial carcinoma, epidemiologic studies continue to define the role of postmenopausal estrogens in endometrial carcinoma risk. This year a Swedish study documents a smaller overall risk from estrogen treatment, perhaps related to a substantially lower use of conjugated estrogens in that country. Combination chemotherapy continues to show some activity, although the contribution of combinations in excess of the single agent activity of doxorubicin is still poorly documented. One study does demonstrate significant activity for the commonly used CAP regimen with an overall response rate of 56% and 28% complete remissions.(ABSTRACT TRUNCATED AT 400 WORDS)