Debate 25A - What is the Optimal Adjuvant Chemotherapy Regimen for Primary Granulosa Cell Tumor?

Summary

The notion that BEP is the optimal chemotherapy regimen for all ovarian germ cell tumors (OGCT) is flawed as there are a number of equally effective and potentially less toxic treatment regimens. OGCTs are highly curable and the focus over recent years has been on minimizing toxicity of treatment and in particular late effects. There has been much effort in de-escalating treatment particularly in patients with advanced stage dysgerminomas with excellent outcomes achieved with carboplatin either alone or in combination. Treatment options for patients with good prognosis, advanced non-dysgerminomatous germ cell tumors include four cycles of etoposide and cisplatin instead of three cycles of BEP. An effective alternative is to substitute ifosfamide for bleomycin and to use three cycles only. In the minority of patients with advanced OGCTs who have adverse prognostic factors, relapse is still high with BEP alone and they should be treated in expert centers with access to clinical trials.