Gestational trophoblastic neoplasia medical therapy
Template:Choriocarcinoma Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Chemotherapy
Low-Risk Gestational Trophoblastic Neoplasia (FIGO Score 0–6)
Treatment commonly used treatment regimens include the following:
- The 8-day charing cross regimen. Methotrexate (50 mg intramuscularly [IM] on days 1, 3, 5, and 7) and folinic acid (7.5 mg orally on days 2, 4, 6, and 8). This may be the most common regimen worldwide
- Biweekly pulsed dactinomycin (1.25 mg/m2 IV)
- Weekly methotrexate (30 mg/m2 IM). Efficacy of this regimen appears to be low for choriocarcinoma and for patients with Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) risk scores of 5 to 6
Other regimens in less-common use include the following:
- An 8-day regimen of methotrexate(1 mg/kg IM days 1, 3, 5, and 7) and folinic acid (0.1 mg/kg IM days 2, 4, 6, and 8)
- Methotrexate 20 mg/m2 IM days 1 to5, repeated every 14 days
- Dactinomycin 12 μg/kg/day IV days 1 to 5, repeated every 2 to 3 weeks
- Methotrexate 20 mg IM daily, days 1 to 5; and dactinomycin 500 μg IV daily, days 1 to 5, repeated every 14 days
- Dactinomycin 10 μg/kg/day, days 1 to 5, repeated every 2 weeks
- Methotrexate 0.4 mg/kg/day IM daily on days 1 to 5, repeated after 7 days
- Etoposide 100 mg/m2/day IV on days 1 to 5, or 250 mg/m2 IV on days 1 and 3, at 10-day intervals
High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment
| Day | Drug | Dose |
| 1 | Etoposide | 100 mg/m2 IV for 30 min |
| Dactinomycin | 0.5 mg IV push | |
| Methotrexate | 300 mg/m2 IV for 12 h | |
| 2 | Etoposide | 100 mg/m2 IV for 30 min |
| Dactinomycin | 0.5 mg IV push | |
| Folinic Acid | 15 mg or PO every 12 h × 4 doses, beginning 24 h after the start of methotrexate | |
| 8 | Cyclophosphamide | 600 mg/m2 IV infusion |
| Vincristine | 0.8–1.0 mg/m2 IV push (maximum dose 2 mg |
Examples of other regimens that have been used include the following:
- MAC: Methotrexate AND folinic acid AND dactinomycin AND cyclophosphamide.
- Another MAC: Methotrexate AND dactinomycin AND chlorambucil.
- EMA: Etoposide AND methotrexate AND folinic acid AND dactinomycin (EMA/CO without the CO).
- CHAMOCA: Methotrexate AND dactinomycin AND cyclophosphamide AND doxorubicin AND melphalan AND hydroxyurea AND vincristine.
- CHAMOMA: Methotrexate AND folinic acid AND hydroxyurea AND dactinomycin AND vincristine AND melphalan AND doxorubicin.