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Table 118-11. POMB/ACE Chemotherapy for Germ Cell Tumors of the Ovary

Table 118-11. POMB/ACE Chemotherapy for Germ Cell Tumors of the Ovary
POMB  
Day 1 Vincrinstine 1mg/m2 IV; methotrexate 300 mg/m2 as a 12-h infusion
Day 2 Bleomycin 15 mg by 24-h infusion; folinic acid rescue started 24 h after the start of methotrexate in a dose of 15 mg every 12 h for 4 doses
Day 3 Bleomycin 15 mg by 24-h infusion
Day 4 Cisplatin 120 mg/m2 as a 12-h infusion, given together with hydration and 3 mg magnesium sulfate supplementation
ACE  
Days 1-5 Etoposide (VP16) 100 mg/m2, days 1 to 5
Days 3-5 Actinomycin D 0.5 mg IV, days 3, 4, and 5
Day 5 Cyclophosphamide 500 mg/m2 IV, day 5
OMB  
Day 1 Vincristine 1 mg/m2 IV; methotrexate 300 mg/m2 as a 12-h infusion
Day 2 Bleomycin 15 mg by 24-h infusion; folinic acid rescue started at 24 h
Day 3 Bleomycin 15 mg by 24-h infusion
Adapted from Berek JS, et al.393 The sequence of treatment schedules is two courses of POMB followed by ACE. POMB is then alternated with ACE until patients are in biochemical remission as measured by hCG and AFP, PLAP and LDH. The usual number of courses of POMB is three to five. Following biochemical remission, patients alternate ACE with OMB until remission has been maintained for approximately 12 weeks. The interval between courses of treatment is kept to the minimum (usually 9 to 11 days). If delays are caused by myelosuppression after courses of ACE, the first 2 days of etoposide are omitted from subsequent courses of ACE.