[Consecutive low-dose cisplatin-based chemotherapy for gynecologic malignancies]

The required elements for chemotherapy for cancer patients may include 1) compliance, 2) response and 3) survival benefit. Among these compliance is considered to be a prerequisite for chemotherapeutic protocol. The reason for this is patients with advanced gynecologic malignancies have possible organic or functional disturbance, some of which are due to cancer invasion. For example, more than 20% of advanced ovarian cancer patients have poor performance status because of massive carcinomatous ascites. Thus, any chemotherapeutic regimen with severe toxicity cannot be applied to such advanced cancer patients even if it has potent anti-tumor activity. CDDP is no doubt a key drug for treatment of gynecologic malignancies. However, toxic effects on renal function is a dose limiting factor. Occasional advanced cervical cancer patients do not meet the eligibility criteria because of renal dysfunction due to involvement of ureter. Based on these findings, the author established a consecutive low-dose CDDP dosing method, which possibly could deliver a higher therapeutic index compared with the bolus-dosing method. In this review, the pharmacokinetic basis for this unique dosing method and obtained clinical data will be discussed. Further, the author recommended a most effective protocol individually for each histological type of gynecologic malignancies, including CDDP-resistant disease.