Etoposide, cisplatin–etoposide, methotrexate, actinomycin-D as primary treatment for management of very-high-risk gestational trophoblastic neoplasia

• Published in: International journal of gynecology and obstetrics Vol. 115; no. 1; pp. 37 - 39
• Main Authors: Cyriac, Sanju, Rajendranath, Rejiv, Sridevi, Veluswami, Sagar, Tenali G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ireland Ltd 01.10.2011
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Cisplatin - administration & dosage; Dactinomycin - administration & dosage; Disease Progression; Etoposide - administration & dosage; Etoposide, cisplatin–etoposide, methotrexate, actinomycin-D; Female; Gestational Trophoblastic Disease - drug therapy; Gestational Trophoblastic Disease - pathology; Gestational Trophoblastic Disease - therapy; Humans; India; Liver Neoplasms - secondary; Methotrexate - administration & dosage; Middle Aged; Obstetrics and Gynecology; Pregnancy; Retrospective Studies; Risk; Salvage; Salvage Therapy - methods; Survival Rate; Treatment Outcome; Trophoblastic disease; Young Adult; India; Chemotherapy; Salvage; Etoposide, cisplatin–etoposide, methotrexate, actinomycin-D; Trophoblastic disease
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2011.04.017

Abstract Objective To evaluate the efficacy of etoposide, cisplatin–etoposide, methotrexate, actinomycin-D (EP–EMA) chemotherapy as the frontline treatment for gestational trophoblastic neoplasia (GTN) patients with very high (≥ 12) FIGO prognostic scores. Methods Nine patients with very-high-risk GTN were treated with EP–EMA at the Cancer Institute, Adyar, India, between January 1, 2001, and December 31, 2007. Salvage chemotherapy, adjuvant surgery, and radiotherapy were used when indicated. Clinical response, toxicity, and survival were analyzed separately. Results The median FIGO score was 15. Six (66.7%) patients had a complete clinical response, whereas progressive disease occurred for 3 (33.3%) women. None of the patients relapsed. This translated to an overall survival rate of 66.7% in the primary setting. All patients with liver-only metastases were survivors after treatment with EP–EMA. Grade 3 neutropenia was detected in 3 (33.3%) patients only. No life-threatening toxicity was observed after EP–EMA treatment. Conclusion EP–EMA was highly effective for the primary management of very-high-risk GTN.