Vincristine, dactinomycin, and cyclophosphamide in the treatment of malignant germ cell tumors of the ovary. A gynecologic oncology group study (a final report)

Abstract

Seventy-six patients with malignant germ cell tumors of the ovary received vincristine, dactinomycin, and cyclophosphamide (VAC) postoperatively. Fifty-four were treated after removal of all gross disease. The majority of these remain disease-free. Indeed, only 15 (28%) have failed, including 11 of 24 with pure endodermal sinus tumor, 3 of 11 (27%) with mixed germ cell tumor containing endodermal sinus elements, and only 1 of 20 with immature teratoma grade 2 or 3, a patient seen initially with recurrent disease. Postoperative VAC therapy, however, did not appear to be effective in patients with unresectable or incompletely resected germ cell tumors of the ovary. Fifteen of 22 patients (68%) with incompletely resected germ cell tumors failed VAC therapy, including 4 of 7 with pure endodermal sinus tumor, 5 of 5 with mixed germ cell tumors containing endodermal sinus elements, 2 of 2 with embryonal carcinoma, and 4 of 8 with immature teratoma. In failing, patients' median time to progression was 8 months. Dose-limiting toxicity was seen in 30% of the entire group. Combined cisplatin, vinblastine and bleomycin therapy now is being tested in this group of tumors.

Ovarian Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology

“…180,[194][195][196][197][198] Most of the combination chemotherapy regimens are recommended as palliative options for patients with recurrent or residual disease who have no curative options. These recurrence regimens (see OV-B, 6 of 7 page 1147) are not generalizable for all of the uncommon histology tumors; therefore, patients should be referred to tertiary care institutions for treatment.…”

Systemic management of malignant ovarian germ cell tumors in older women: two case reports and a review of the literature

“…In a study of adjuvant VAC (vincristine, dactinomycin, cyclophosphamide) in eleven patients with minimal residual disease after surgery (defined as ≤3 cm), six (55%) experienced recurrence over a median follow-up period of 24 months. In contrast, 9 of 11 (82%) with residual nodules exceeding 3 cm in diameter recurred over the same time period [49]. In another study, patients with clinically non-measurable disease had a higher likelihood of remaining progression free at 2 years (65% vs. 34%) [50].…”

Therapie von Keimstrang-Stroma-Tumoren und Keimzelltumoren des Ovars

“…Die Gynecologic Oncology Group (GOG) berichtete im Rahmen einer Studie mit Vincristin, Actinomycin und Cyclophosphamid von einer Versagerrate von 68 bei Patientinnen mit inkomplett reseziertem Tumor im Vergleich zu 28 bei Frauen mit komplett reseziertem [30]. Eine zweite GOG-Studie mit Cisplatin, Vinblastin und Bleomycin bei Frauen mit fortgeschrittenem Keimzelltumor erbrachte ähnliche Ergebnisse zugunsten der tumorreduktiven Vorgehensweise [34].…”