From the Guidelines
The recommended chemotherapy regimen for FIGO stage 2 dysgerminoma is BEP (bleomycin, etoposide, and cisplatin) for 3-4 cycles. The typical dosing includes bleomycin 30 units IV on days 1,8, and 15, etoposide 100 mg/m² IV on days 1-5, and cisplatin 20 mg/m² IV on days 1-5, repeated every 21 days 1. For patients with concerns about pulmonary toxicity, an alternative regimen is EP (etoposide and cisplatin) for 4 cycles. Dysgerminoma is highly chemosensitive, with cure rates exceeding 90% even with advanced disease 1.
Key Considerations
- Treatment should be administered by a gynecologic oncologist or medical oncologist with experience in germ cell tumors.
- Patients require close monitoring for side effects including myelosuppression, nephrotoxicity, ototoxicity, and pulmonary toxicity.
- Fertility preservation should be discussed before treatment as many patients are young women of reproductive age 1.
- After completion of chemotherapy, patients need regular follow-up with physical examinations, tumor markers, and imaging studies for at least 5 years to monitor for recurrence 1.
Chemotherapy Regimen
- BEP regimen: bleomycin 30 units IV on days 1,8, and 15, etoposide 100 mg/m² IV on days 1-5, and cisplatin 20 mg/m² IV on days 1-5, repeated every 21 days.
- Alternative EP regimen for patients with concerns about pulmonary toxicity: etoposide and cisplatin for 4 cycles.
Supporting Evidence
The recommendation is based on the most recent and highest quality studies, including the NCCN clinical practice guidelines in oncology 1 and the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of non-epithelial ovarian cancer 1. These guidelines support the use of BEP chemotherapy for FIGO stage 2 dysgerminoma, with consideration of alternative regimens for patients with concerns about pulmonary toxicity.
From the Research
Chemotherapy Regimens for Dysgerminoma at FIGO Stage 2
The recommended chemotherapy regimen for a patient with dysgerminoma at FIGO stage 2 is typically based on the principles of treating ovarian germ cell tumors.
- The BEP regimen, which consists of bleomycin, etoposide, and cisplatin, is commonly used and has shown high efficacy in treating dysgerminoma, as reported in studies 2, 3, 4, 5.
- In the study by 2, a 2-day BEP regimen was used, with etoposide dosage fixed at 120 mg/m2 on day 1 and day 2, bleomycin 15 mg intravenous bolus on days 1 and 2, and cisplatin 100 mg/m2 on day 1, administered at four weekly intervals for 4 cycles or until complete response was achieved.
- Another study by 6 used a PVB regimen, which consists of cisplatin, vinblastine, and bleomycin, and reported a high response rate, but noted that the BEP regimen is preferred due to its equal potency and lower toxicity.
- The choice of chemotherapy regimen may depend on various factors, including the patient's overall health, the extent of the disease, and the presence of any comorbidities.
Efficacy and Safety of Chemotherapy Regimens
- The BEP regimen has been shown to be highly effective in treating dysgerminoma, with complete response rates ranging from 66% to 100% in various studies 2, 3, 4, 5.
- The safety profile of the BEP regimen is generally acceptable, with common side effects including nausea, vomiting, alopecia, and myelosuppression 2, 6, 3, 4, 5.
- The modified 3-day BEP regimen used in the study by 5 was found to be safe and effective, with a low incidence of grade 3 or 4 neutropenia and no treatment-related deaths.
Treatment Outcomes
- The overall disease-free survival rate for patients with dysgerminoma treated with the BEP regimen is high, ranging from 78% to 96% in various studies 2, 6, 3, 4, 5.
- The prognosis for patients with dysgerminoma at FIGO stage 2 is generally good, with a high likelihood of cure with appropriate treatment 2, 6, 3, 4, 5.