Advances in the chemotherapy of gynecologic cancer

By combining paclitaxel and cisplatin in treatment schedules for the initial treatment of advanced ovarian cancer, new hope has been engendered that we can further improve survival. With premedication, paclitaxel can be administered safely as a short infusion. The combination of paclitaxel and carboplatin is recognized as an alternative to the combination of cisplatin and paclitaxel, and is now under study to define its role in future treatment programs. Other new drugs have been recognized as active in platinum-resistant disease, including docetaxel and gemcitabine. Renewed interest arose for a chronic low dose of oral etoposide in platinum-refractory ovarian cancer. The results obtained with chemotherapy in cervical cancer have always been modest, and no combinations have been shown to result in improved survival rates as compared with single drugs. The novel biologic regimen, using retinoids and interferon, was confirmed to be active in locally advanced cervical cancer. In trophoblastic disease, the Charing Cross scoring system is a relevant pretreatment scoring system compared with the International Federation of Gynecology of Obstetrics staging. Careful recognition of prognostic subgroups can prevent under- or overtreatment.