Medication Summary
The goal of pharmacotherapy in most women is remission. During chemotherapy, supportive medications are used to reduce morbidity and prevent the complications of chemotherapy.
Antineoplastic Agents
Class Summary
Treatment entails chemotherapy and radiation therapy. Lesions staged higher than stage Ia require a combination of BEP (bleomycin, etoposide, platinum). Alternate combinations are VAC (vincristine, actinomycin D, cyclophosphamide) or PVB (cisplatin, vincristine, bleomycin), but these combinations have higher toxicity and/or lower response rates. Etoposide and carboplatin should be considered if the patient has significant renal, pulmonary, or neurologic impairment.
Bleomycin (Blenoxane)
Bleomycin is a copper-chelating glycoprotein capable of inducing DNA strand scission breaks via oxidative processes. This drug is eliminated by the kidneys.
Carboplatin (Paraplatin)
Carboplatin is an analog of cisplatin. This is a heavy metal coordination complex that exerts its cytotoxic effect by plastination of DNA, a mechanism analogous to alkylation, leading to interstrand and intrastrand DNA cross-links and inhibition of DNA replication. Carboplatin binds to protein and other compounds containing the SH group. Cytotoxicity can occur at any stage of the cell cycle, but the cell is most vulnerable to the action of these drugs in G1 and S phase.
Carboplatin has the same efficacy as cisplatin but with a better toxicity profile. Its main advantages over cisplatin include less nephrotoxicity and ototoxicity not requiring extensive prehydration and less likelihood of inducing nausea and vomiting, but it is more likely to induce myelotoxicity.
The dose is based on the following formula: total dose (mg) = (target AUC) x (GFR+25), where AUC (area under plasma concentration-time curve) is expressed in mg/mL/min and GFR (glomerular filtration rate) is expressed in mL/min.
Etoposide (Toposar)
Etoposide inhibits topoisomerase II and causes DNA strand breakage, causing cell proliferation to arrest in the late S or early G2 portion of the cell cycle.
Therapy should be withheld or suspended if platelet counts are less than 50,000 or absolute neutrophil counts are less than 500/µL.
Reduce the dose by 20% for granulocytic fever or previous radiotherapy.
Cisplatin (Platinol)
Cisplatin inhibits DNA synthesis and, thus, cell proliferation, by causing DNA cross-links and denaturation of the double helix.
In general, the drug should not be administered if the leukocyte count is less than 4000/µL and platelet count is less than 100,000/µL. Cisplatin is renally excreted; those with impaired renal function should postpone therapy. Do not administer to patients with serum creatinine greater than 1.5 mg/dL and BUN greater than 25 mg/dL.
It is administered intravenously in saline solution.
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Ovarian dysgerminomas. Microscopic image at 20 X.
