Debate 24B - What is the Optimal Chemotherapy Regimen for Ovarian Germ-cell Tumors?

Summary

Advanced malignant ovarian germ cell tumors (MOGCT), like their testicular counterparts, are exquisitely sensitive to platinum- and etoposide-based chemotherapy. More than 40 years ago Einhorn and colleagues discovered that bleomycin added to this combination was an effective treatment. The resulting five-day bleomycin etoposide and cisplatin (BEP) chemotherapy given three-weekly for three to four cycles depending on disease extent was internationally adopted. Subsequently, many other regimens have been developed attempting to reduce toxicity and/or improve efficacy. However, no randomized controlled trial data exists to demonstrate that any of these are superior to BEP chemotherapy. Moreover, as MOGCT differs from testicular disease in that relapses after primary chemotherapy have much lower survival rates, de-escalation of primary treatment is to be discouraged. Consequently, there is no debate as BEP remains the current standard of care for women presenting with advanced MOGCT.