Cisplatin

Abstract

Cis-platinum has made a major impact in the treatment of genitourinary, gynecologic and head and neck cancer. The drug has significant activity in testicular malignancies, bladder cancer, ovarian cancer, cervix cancer and sqaumous cell cancers of the head and neck area. In each of these tumors, cis-platinum has become a focal point for combination chemotherapy studies. NCOG has studies for each of these tumors, utilizing cis-platinum which illuminates the major clinical research thrusts. In metastatic or Stage 3 testicular cancer of the non-seminomatous variety, NCOG is studying the combination of cis-platinum, vinblastine and bleomycin (PVB) with and without the addition of lithium carbonate. In Stage 2 non-seminomatous disease, NCOG is participating in a national study in which after lymphadenectomy the randomization is to PVB or observation. In metastatic bladder cancer, an unanswered question is whether combinations utilizing cis-platinum are superior to cis-platinum alone. NCOG is currently randomizing patients to platinum alone versus the three-drug combination of platinum, adriamycin and cyclophosphamide (PAC). In locally advanced bladder cancer, NCOG is studying pre-operative irradiation with and without cis-platinum. In ovarian cancer, NCOG has an extensive experience with the PAC combination in nearly 100 patients treated in single arm fashion. While this combination is highly active, it is not dramatically superior to our earlier experience with adriamycin and cyclophosphamide alone (ACe). Our current protocol randomizes women with Stage 3 and 4 (FIGO) disease to PAC or ACe. This protocol has also involves both cytoreductive and second-look surgery in an attempt to increase the women who have prolonged disease-free survival. In carcinoma of the uterine cervix, NCOG is testing a three-drug combination of platinum, bleomycin and mitomycin C. NCOG is studying platinum in head and neck cancer in two situations. For advanced lesions, the randomization is to platinum alone or platinum plus methotrexate. In operable Stage 3 and 4 disease, NCOG is part of a national 3 arm study. One group will receive surgery and postoperative irradiation. A second group receives one course of platinum and bleomycin preoperatively. A third group receives the pre-operative chemotherapy and six cycles of platinum after the irradiation.