Primary treatment of metastatic high-risk gestational trophoblastic neoplasia with EMA-CO chemotherapy.

Abstract

OBJECTIVE:

To evaluate the efficacy of etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) in the primary treatment of metastatic high-risk gestational trophoblastic neoplasia.

STUDY DESIGN:

Thirty women with metastatic high-risk gestational trophoblastic neoplasia were treated primarily with EMA-CO between 1986 and 2005. Patients who had incomplete responses or developed resistance to EMA-CO were treated with drug combinations employing etoposide and a platinum agent with or without bleomycin or ifosfamide. Adjuvant surgery and radiotherapy were used in selected patients. Survival, clinical response and factors affecting treatment success were analyzed retrospectively.

RESULTS:

The overall survival rate was 93.3% (28 of 30). Of the 30 patients treated with EMA-CO, 20 (66.7%) had a lasting clinical response, 8 (26.7%) developed resistance but were subsequently placed in remission with platinum-based chemotherapy, and 2 (6.7%) died of widespread metastatic disease. Clinical complete response to EMA-CO was significantly influenced by human chorionic gonadotropin level (<100,000 mIU/ mL, 82%, vs. > 100,000 mIU/mL, 46%), metastatic site (lung and pelvis, 75%, vs. other, 33%) and International Federation of Gynecology and Obstetrics (FIGO) risk factor score (< 7, 92% vs. >7, 50%). Surgical procedures were performed on 12 patients, and 4 patients received brain irradiation. Eight (80%) of 10 patients who received secondary platinum-based chemotherapy or without surgery were cured. The 2 patients who died had stage IV disease (brain and/or liver metastases) with FIGO scores of 13 and 14.

CONCLUSION:

Over 93% of 30 patients with metastatic high-risk gestational trophoblastic neoplasia treated initially with the EMA-CO protocol, often in conjunction with brain irradiation, surgical resection of sites of persistent tumor and salvage platinum-based chemotherapy, were cured.

• Authors: John R Lurain, Diljeet K Singh, Julian C Schink
• Journal: The Journal of reproductive medicine (J Reprod Med) Vol. 51 Issue 10 Pg. 767-72 (Oct 2006) ISSN: 0024-7758 [Print] United States
• PMID: 17086804 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Dactinomycin
• Vincristine
• Etoposide
• Cyclophosphamide
• Methotrexate

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Cyclophosphamide (administration & dosage)
• Dactinomycin (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Gestational Trophoblastic Disease (drug therapy, mortality, pathology)
• Humans
• Illinois
• Medical Records
• Methotrexate (administration & dosage)
• Middle Aged
• Neoplasm Metastasis
• Pregnancy
• Retrospective Studies
• Survival Analysis
• Treatment Outcome
• Uterine Neoplasms (drug therapy, mortality, pathology)
• Vincristine (administration & dosage)