Escobar PF,
Lurain JR,
Singh DK,
Bozorgi K,
Fishman DA.
Treatment of
high-risk gestational trophoblastic neoplasia with etoposide,
methotrexate, actinomycin D, cyclophosphamide, and vincristine
chemotherapy
Gynecol Oncol. 2003 Dec;91(3):552-7
OBJECTIVE: The objective of the study was to evaluate the
efficacy and toxicity of etoposide, methotrexate, actinomycin D,
cyclophosphamide, and vincristine (EMA-CO) chemotherapy for the
treatment of high-risk gestational trophoblastic neoplasia.
METHODS: Forty-five patients with high-risk gestational
trophoblastic tumors received 257 EMA-CO treatment cycles
between 1986 and 2001. Twenty-five were treated primarily with
EMA-CO because of the presence of one or more high-risk factors
and 20 were treated with EMA-CO secondarily after failure of
single-agent chemotherapy. Patients who had incomplete responses
or developed resistance to EMA-CO were treated with drug
combinations employing cisplatin and etoposide with or without
bleomycin or ifosfamide. Adjuvant surgery and radiotherapy were
used in selected patients. Survival, clinical response, and
toxicity were analyzed retrospectively. RESULTS: The overall
survival rates was 91% (41/45); survival rates were 92% (23/25)
for primary treatment and 90% (18/20) for secondary treatment
with EMA-CO. Of the 45 patients treated with EMA-CO, 32 (71%)
had a complete clinical response, 9 (20%) developed resistance
but were subsequently placed into remission with cisplatin-based
chemotherapy, and 4 (9%) died of widespread metastatic disease.
Clinical complete response to EMA-CO was significantly
influenced by duration of disease from antecedent pregnancy to
treatment (<6 months, 84%, vs >6 months, 43%), metastatic site
(lung and pelvis, 73%, vs other, 40%), and WHO score (< or =7,
96%, vs >7, 36%). The EMA-CO chemotherapy regimen produced no
life-threatening toxicity, caused grade 3-4 hematologic toxicity
in 1.6% of cycles, and was associated with neutropenia
necessitating a 1-week delay in treatment in only 13.5% of
cycles. CONCLUSION: EMA-CO chemotherapy is a well-tolerated and
highly effective treatment for high-risk gestational
trophoblastic neoplasia, yielding a 71% complete response rate
and a 91% survival rate in this series. |
