EFFECTIVENESS AND TOXICITY DIFFERENCES BETWEEN THE USE OF REGIMEN CHEMOTHERAPY BLEOMYCIN-VINCRISTINE-MITOMYCIN-CISPLATIN AND BLEOMYCIN- VINCRISTINE-MITOMYCIN-CARBOPLATIN FOR THREE CYCLES IN PATIENTS CERVICAL CANCER SQUAMOUS CELL STADIUM IIB-IIIB IN SANGLAH GENERAL HOSPITAL DENPASAR BALI Research Article
Objectives: Medicines in the market need their security and their effectiveness monitored to ensure patient safety, which is called Clinical Testing
Stage IV. Cytotoxic medicines especially those for cervical cancer chemotherapy, particularly need to be monitored. These medicines include two
combinations: Bleomycin-vincristine-mitomycin-cisplatin (BOM-cisplatin) and bleomycin-vincristine-mitomycin-carboplatin (BOM-carboplatin).
Both these combinations are commonly used for cervical cancer treatments in Sanglah General Hospital. Up till now, there has not been adequate
data to differentiate between the two combinations. Therefore, we conducted the research to explore the relative effectiveness and toxicity of
both combinations. The assessment of both combinations can be seen using parameter squamous cell carcinoma (SCC) and tumor-mass. Toxicity
assessment of the chemotherapy can be seen by judging functions of the liver (serum glutamic oxaloacetic transaminase [SGOT], serum glutamic
pyruvic transaminase [SGPT]), kidneys (blood urea nitrogen [BUN], creatinine), and blood (leukocytes, hemoglobin) of patients.
Methods: The observational research with the cross-sectional method in Obstetrics and Gynecology Clinics in Sanglah General Hospital Denpasar
Bali. Research on both combinations was carried out between 2013 and 2015. The samples were obtained before the 1
chemotherapy and after the
chemotherapy, by using consecutive sampling method. Prodia Clinical Laboratory carried out examinations on levels of SCC, while tumor-mass and
the other parameters were carried out by Clinical Pathology Laboratory Sanglah General Hospital. Data were analyzed with the paired t-test with 95%
confidence interval, using SPSS 17.0 for Windows.
Results: Samples used in this research was 12 patients who got combination BOM-cisplatin and 9 patients who got combination BOM-carboplatin.
In the group of BOM-cisplatin, there is no difference of content of leukocytes, hemoglobin, creatinine, BUN, SGOT, SGPT, and SCC before the
chemotherapy and after the 3
chemotherapy (*p>0.05). However, there are different levels of tumor mass before the 1
chemotherapy and after
chemotherapy (*p<0.05). In the group of BOM-carboplatin, there are no differences in the levels of Creatinine, BUN, SGPT, SGOT, tumor mass,
and SCC (*p>0.05). However, there are different levels of leukocytes and hemoglobin (*p<0.05).
Conclusion: The use of combination BOM-cisplatin can be said to be effective by the change of patients' tumor-mass after undergoing chemotherapy.
The combination BOM-carboplatin is not effective because there were no changes in patients' tumor-mass and patients' levels of antigen SCC, and has
toxic effects on patients' blood after undergoing chemotherapy.
Keywords: Effectiveness, Toxicity, Bleomycin-vincristine-mitomycin-cisplatin, Bleomycin-vincristine-mitomycin-carboplatin, Cervical cancer.
1. Florento L, Matias R, TuaÃ±o E, Santiago K, Dela Cruz F, Tuazon A.
Comparison of cytotoxic activity of anticancer drugs against various
human tumor cell lines using in vitro cell-based approach. Int J Biomed
2. World Health Organitation. Cancer Control Knowledge into Action.
Geneva: World Health Organitation; 2007.
3. Choi JS, Koren G, Nulman I. Pregnancy and isotretinoin therapy.
4. Taneja A, Rajaram S, Agarwal S, Singh KC, Sahni S, Goel N. Quick
cycle neoadjuvant chemotherapy in squamous cell carcinoma of cervix.
Indian J Pharmacol 2005;37(5):320-4.
5. Yin M, Hou Y, Zhang T, Cui C, Zhou X, Sun F, et al. Evaluation of
chemotherapy response with serum squamous cell carcinoma antigen
level in cervical cancer patients: A prospective cohort study. PLoS One
6. Buda A, Fossati R, Colombo N, Fei F, Floriani I, Gueli Alletti D, et al.
Randomized trial of neoadjuvant chemotherapy comparing paclitaxel,
ifosfamide, and cisplatin with ifosfamide and cisplatin followed
by radical surgery in patients with locally advanced squamous cell
cervical carcinoma: The SNAP01 (studio neo-adjuvante portio) Italian
collaborative study. J Clin Oncol 2005;23(18):4137-45.
7. Miller RP, Tadagavadi RK, Ramesh G, Reeves WB. Mechanisms of
cisplatin nephrotoxicity. Toxins (Basel) 2010;2(11):2490-518.
8. Indonesia Departement of Health. Guidelines for the Interpretation of
Clinical Data. Jakarta: Indonesia Departement of Health; 2012.
9. Wang J, Lu Z, Au JL. Protection against chemotherapy-Induced
alopecia. Pharm Res 2006;23(11):2505-14.
10. Ariawati K, Endang WD, Gatot D. Toxixity of chemotherapy,
lymphoblastic leukemia acute in induction and prophylaxis phase
of CNS with 1 gram methotrexate. Faculty of Medicine, Udayana
11. Testa, JN. Heardy, Molineux G. Long term bone marrow damage after
cytotoxic treatment: Stem cells and microenvironment. In: Testa NG,
Gale RP, editors. Hematopoiesis. Vol. 82. New York, NY, USA: Marcel
Dekker; 1988. p. 51-6.
12. Liu W, Zhang CC, Li K. Prognostic value of chemotherapy-Induced
leukopenia in small-cell lung cancer. Cancer Biol Med 2013;10(2):92-8.
13. Park TK, Kim SN, Kim SW, Kim GE, Suh CO. Concurrent
chemotherapy and radiotherapy in invasive cervical cancer patients
with high risk factor. J Korean Med Sci 2000;15(4):436-41.
14. Thapa BR, Walia A. Liver function tests and their interpretation. Indian
J Pediatr 2007;74(7):663-71.
15. Rauf S, Prefitri AM, Irianta T, Chalid MT. The role of squamous cell
carsinoma and carsino embryonic antigen in determining the clinical
response of advanced stage cervical cancer patients undergoing
bleomycin, oncovin, mitomycin-c, cisplatin chemotherapy. Oncology
Division, Departement of Obstetrics and Gynecology, Medical Faculty
Hasanuddin University and Obstetrics and Gynecology Wahidin
Sudirohusodo Hospita, Makasar; 2006.
16. Joshi M, Sodhi KS, Pandey R, Singh J, Goyal S, Prasad S, et al. Cancer
chemotherapy and hepatotoxicity: An update. IAJPR 2014;4(6):2976-84.
17. Hruban RH, Sternberg SS, Meyers P, Fleisher M, Menendez-Botet C,
Boitnott JK. Fatal thrombocytopenia and liver failure associated with
carboplatin therapy. Cancer Invest 1991;9(3):263-8.
18. Indonesia Departement of Health. Guidelines for the Interpretation of
Asian J Pharm Clin Res, Vol 9, Suppl. 2, 2016, 149-153
Noviyani et al.
Clinical Data. Jakarta: Indonesia Departement of Health; 2009.
19. Kobayashi R, Suzuki A, Matsuura K, Yamada N, Nakano M, Deguchi T,
et al. Risk analysis for cisplatin-induced nephrotoxicity during first
cycle of chemotherapy. Int J Clin 2016;9(2):3635-41.
20. Yoon SM, Shin KH, Kim JY, Seo SS, Park SY, Moon SH, et al.
Use of serum squamous cell carcinoma antigen for follow-up
monitoring of cervical cancer patients who were treated by concurrent
chemoradiotherapy. Radiat Oncol 2010;5:78.
21. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix,
and endometrium. Int J Gynaecol Obstet 2009;105(2):103-4.
22. Sturgeon CM, Diamandis E. Laboratory Medicine Practice Guidelines:
Use of Tumor Markers in Liver, Bladder, Cervical, and Gastric Cancers.
Washington: American Association for Clinical Chemistry; 2010.
23. Irawan A. Cautious Tumor and Cancer. Bandung: Carya Remaja;
2001. p. 1-5.
24. Liu K, Wang GB, Cheng B, Qiu DB. Clinical comparison of GC
regimen (gemcitabine and cisplatin) versus FEC regimen (fluorouracil,
epirubicin, and cyclophosphamide) as neoadjuvant chemotherapy for
breast cancer. Ai Zheng 2007;26(4):427-30.
25. Gaarenstroom KN, Kenter GG, Bonfrer JM, Korse CM,
Van de Vijver MJ, Fleuren GJ, et al. Can initial serum cyfra 21-1, SCC
antigen, and TPA levels in squamous cell cervical cancer predict lymph
node metastases or prognosis? Gynecol Oncol 2000;77(1):164-70.
26. Micke O, Bruns F, SchÃ¤fer U, Prott FJ, Willich N. The impact of
squamous cell carcinoma (SCC) antigen in patients with advanced
cancer of uterine cervix treated with (chemo-) radiotherapy. Anticancer
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