Combination chemotherapy with 5-fluorouracil, methotrexate and etoposide for patients with high-risk gestational trophoblastic tumors: a report based on our 11-year clinical experiences.

Abstract

OBJECTIVES:

To evaluate the efficacy, toxicity, and survival of patients with high-risk gestational trophoblastic tumors (GTTs) treated with the 5-fluorouracil (5-FU), methotrexate (MTX) and etoposide (VP-16) regimen.

METHODS:

Between 1992 and 2003, 26 consecutive patients with FIGO-defined high-risk GTTs were treated with 5-FU, MTX and VP-16 regimen. Among them, 9 patients had received prior chemotherapy. Remission rate, causes of treatment failure, and toxicity were analyzed retrospectively.

RESULTS:

After treatment with 5-FU, MTX and VP-16 regimen, 21 of 26 gained complete respond (80.8%). Two patients were performed adjuvant hysterectomy and both cured ultimately. Five developed resistance (19.2%), and 1 died of widespread metastases (3.8%). All 5 patients who developed resistance were treated with multidrug regimen of etoposide, methotrexate, and actionmycin D alternating with cyclophosphamide and vincristine (the EMA/CO); 4 were salvaged and 1 died of refractory disease. No ones relapsed. WHO grade 4 leukocytopenia and thrombocytopenia with the 5-FU, MTX and VP-16 regimen occurred in 9.0% and 2.4%, respectively, of the total 167 cycles; other toxic effects were acceptable and manageable. With mean follow up of 37 months, neither relapse nor secondary tumor was observed.

CONCLUSIONS:

According to our 11 years of clinical observation, 5-FU, MTX and VP-16 chemotherapy is one of effective multiagent regimen for patients with high-risk GTTs. Its toxicity is mild and manageable. For patients with high-risk and refractory GTTs, this new triple salvage chemotherapy regimen may be an effective alternative.

• Authors: Shu Wang, Ruifang An, Xiaobing Han, Kexiu Zhu, Yan Xue
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 103 Issue 3 Pg. 1105-8 (Dec 2006) ISSN: 0090-8258 [Print] United States
• PMID: 16870237 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Etoposide
• Fluorouracil
• Methotrexate

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• China
• Drug Resistance, Neoplasm
• Etoposide (administration & dosage)
• Female
• Fluorouracil (administration & dosage)
• Humans
• Methotrexate (administration & dosage)
• Neoplasm Recurrence, Local (drug therapy, mortality, pathology)
• Neoplasm Staging
• Survival Analysis
• Treatment Outcome
• Trophoblastic Neoplasms (drug therapy, mortality, pathology)
• Uterine Neoplasms (drug therapy, mortality, pathology)