Salvage chemotherapy for high-risk gestational trophoblastic tumor.

Abstract

OBJECTIVE:

To evaluate the efficacy and safety of etoposide/methotrexate/actinomycin D (MEA regimen) as initial chemotherapy and 5-fluorouracil/actinomycin D (FA regimen) as salvage chemotherapy for high-risk gestational trophoblastic tumor (GTT).

STUDY DESIGN:

From 1985 to 2001, 36 patients with World Health Organization (WHO)--defined high-risk GTT were treated with MEA or FA at Chiba University Hospital. Thirty-three patients were initially treated with MEA. FA was administered to 11 patients; 1 had had no previous chemotherapy, 7 had developed drug resistance to MEA, 1 had relapsed following MEA, and 2 had relapsed following etoposide/methotrexate/actinomycin D/ cyclophosphamide/vincristine (EMA/CO) combination chemotherapy.

RESULTS:

The primary remission rate with MEA was 69.7% (23 of 33). With FA the survival rate was 81.8% (9 of 11) for a mean follow-up period of 11.5 years. Two patients died due to multidrug resistance, and 2 patients relapsed subsequently. The 2 relapse cases were successfully salvaged again with MEA. The toxicity of FA was evaluated in 89 cycles. Myelosuppression seemed to be the dose-limiting toxicity, and the incidence of WHO grade 4 leukocytopenia and thrombocytopenia were 5.6% and 3.4%, respectively.

CONCLUSION:

Although etoposide-containing chemotherapy is currently the most effective and well tolerated regimen for high-risk GTT, 20-30% of patients develop drug resistance to these regimens. Salvage combination chemotherapy with FA is effective for refractory patients, and the toxicity is predictable and manageable.

• Authors: Hideo Matsui, Yoshinori Iitsuka, Kiyomi Suzuka, Koji Yamazawa, Akira Mitsuhashi, Souei Sekiya
• Journal: The Journal of reproductive medicine (J Reprod Med) Vol. 49 Issue 6 Pg. 438-42 (Jun 2004) ISSN: 0024-7758 [Print] United States
• PMID: 15283050 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Dactinomycin
• Etoposide
• Leucovorin
• Methotrexate

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Dactinomycin (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Gestational Trophoblastic Disease (drug therapy, pathology)
• Humans
• Leucovorin (administration & dosage)
• Methotrexate (administration & dosage)
• Middle Aged
• Risk Factors
• Salvage Therapy
• Treatment Outcome