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{{Choriocarcinoma}}
{{Gestational trophoblastic neoplasia}}
{{CMG}}
{{CMG}}{{AE}}{{MD}}
==Overview==
The mainstay of therapy for choriocarcinoma is [[chemotherapy]].
==Medical Therapy==
 
====Low-risk gestational trophoblastic neoplasia (FIGO Score 0–6)====
* The initial regimen is generally given until a normal beta [[human chorionic gonadotropin]] ([[Human chorionic gonadotropin|beta-hCG]]) is achieved and sustained for 3 consecutive weeks (or at least for one treatment cycle beyond normalization of the beta-hCG).
* A salvage regimen is instituted if any of the following occur:
:* A plateau of the [[beta-hCG]] for 3 weeks (defined as a [[Human chorionic gonadotropin|beta-hCG]] decrease of 10% or less for 3 consecutive weeks)
:* A rise in [[Human chorionic gonadotropin|beta-hCG]] of greater than 20% for 2 consecutive weeks
:* Appearance of [[metastasis]]
The chemotherapy regimen in the first-line management of low-risk gestational trophoblastic neoplasia (GTN) treatment include the following:<ref name="abc">Low-Risk Gestational Trophoblastic Neoplasia (FIGO Score 0–6) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_326 Accessed on October 8, 2015</ref>
 
* Preferred regimen(1): [[Methotrexate]] 50 mg IM on days 1, 3, 5, and 7 {{and}} [[folinic acid]] 7.5 mg PO on days 2, 4, 6, and 8 (most common)
* Preferred regimen(2):  [[Dactinomycin]] 1.25 mg/m2 IV biweekly pulsed
* Preferred regimen(3):  [[Methotrexate]] 30 mg/m2 IM weekly
* Alternative regimen(1): [[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
* Alternative regimen(2): [[Methotrexate]] 20 mg/m2 IM days 1 to 5, repeated every 14 days
* Alternative regimen(3): [[Dactinomycin]] 12 μg/kg/day IV days 1 to 5, repeated every 2 to 3 weeks
* Alternative regimen(4): [[Methotrexate]] 20 mg IM daily, days 1 to 5 {{and}} [[dactinomycin]] 500 μg IV daily, days 1 to 5, repeated every 14 days
* Alternative regimen(5): [[Dactinomycin]] 10 μg/kg/day, days 1 to 5, repeated every 2 weeks
* Alternative regimen(6): [[Methotrexate]] 0.4 mg/kg/day IM daily on days 1 to 5, repeated after 7 days
* Alternative regimen(7): [[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====
* Preferred regimen: EMA/CO (i.e., [[etoposide]], [[methotrexate]], and [[dactinomycin]]/[[cyclophosphamide]] and [[vincristine]]) is the most commonly used regimen.
* The specifics are provided in table below.<ref name="xxx">High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_328 Accessed on October 8, 2015</ref>
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| align="center" style="background:#f0f0f0;" |'''Day'''
| align="center" style="background:#f0f0f0;" |'''Drug'''
| align="center" style="background:#f0f0f0;" |'''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|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
|}
Cycles are repeated every 2 weeks (on days 15, 16, and 22) until any metastasis present at diagnosis disappear and serum beta-human chorionic gonadotropin (beta-hCG) has normalized, then the treatment is usually continued for an additional three to four cycles.
* Alternative regimen(1): MAC: [[Methotrexate]] {{and}} [[folinic acid]] {{and}} [[dactinomycin]] {{and}} [[cyclophosphamide]]<ref>High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_328 Accessed on October 8, 2015</ref>
* Alternative regimen(2): Another MAC: [[Methotrexate]] {{and}} [[dactinomycin]] {{and}} [[chlorambucil]]
* Alternative regimen(3): EMA: [[Etoposide]] {{and}} [[methotrexate]]  {{and}} [[folinic acid]]  {{and}} [[dactinomycin]] (EMA/CO without the CO)
* Alternative regimen(4): CHAMOCA: [[Methotrexate]] {{and}} [[dactinomycin]] {{and}} [[cyclophosphamide]] {{and}} [[doxorubicin]] {{and}} [[melphalan]] {{and}} [[hydroxyurea]] {{and}} [[vincristine]]
* Alternative regimen(5): CHAMOMA: [[Methotrexate]] {{and}} [[folinic acid]] {{and}} [[hydroxyurea]] {{and}} [[dactinomycin]] {{and}} [[vincristine]] {{and}} [[melphalan]] {{and}} [[doxorubicin]]
 
=====Brain metastasis=====
* Systemic [[methotrexate]] as part of the EMA component (i.e., [[etoposide]], [[methotrexate]], [[folinic acid]], and [[dactinomycin]]) /CO (1 g/m2 IV for 24 hours, followed by folinic-acid rescue, 15 mg PO q6h for 12 doses starting 32 hours after methotrexate).
* Patients with [[brain]] [[metastasis]] received an increased dose of systemic [[methotrexate]] of 1 g/m2 for 24 hours followed by folinic acid (15 mg PO q6h for 12 doses starting 32 hours after [[methotrexate]]).
 
==Placental Site Trophoblastic Tumor Treatment==


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* [[Tumors]] confined to the [[uterus]] (Féderation Internationale de Gynécologie et d’Obstétrique [FIGO] Stage I)
:* [[Hysterectomy]] is the treatment of choice


==Overview==
* [[Tumors]] with extrauterine spread to genital structures (FIGO stage II)
:* Complete resection with or without [[adjuvant chemotherapy]]


==Chemotherapy==
* Metastatic tumors (FIGO stages III and IV)
Choriocarcinoma is one of the tumors that is most sensitive to [[chemotherapy]]. The cure rate, even for metastatic choriocarcinoma, is around 90-95%. Virtually everyone without metastases can be cured however metastatic disease to the kidneys and/or brain is usually fatal. Chemotherapy regimen include EMACO ([[etoposide]], [[methotrexate]], [[actinomycin D]], [[cyclosphosphamide]] and [[oncovin]]).
:* Polyagent chemotherapy
:* EMA/CO: [[Etoposide]] {{and}} [[methotrexate]] with [[folinic acid]] rescue {{and}} [[dactinomycin]] {{and}} [[cyclophosphamide]] {{and}} [[vincristine]](most common)
:* EP/EMA: [[Etoposide]] {{and}} [[cisplatin]] {{and}} [[etoposide]] {{and}} [[methotrexate]] {{and}} [[dactinomycin]]
:* MAE: [[Methotrexate]] with [[folinic acid]] rescue {{and}} [[dactinomycin]] {{and}} [[etoposide]]


==References==
==References==
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[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Oncology]]


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Latest revision as of 15:30, 13 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]

Overview

The mainstay of therapy for choriocarcinoma is chemotherapy.

Medical Therapy

Low-risk gestational trophoblastic neoplasia (FIGO Score 0–6)

  • The initial regimen is generally given until a normal beta human chorionic gonadotropin (beta-hCG) is achieved and sustained for 3 consecutive weeks (or at least for one treatment cycle beyond normalization of the beta-hCG).
  • A salvage regimen is instituted if any of the following occur:
  • A plateau of the beta-hCG for 3 weeks (defined as a beta-hCG decrease of 10% or less for 3 consecutive weeks)
  • A rise in beta-hCG of greater than 20% for 2 consecutive weeks
  • Appearance of metastasis

The chemotherapy regimen in the first-line management of low-risk gestational trophoblastic neoplasia (GTN) treatment include the following:[1]

  • Preferred regimen(1): Methotrexate 50 mg IM on days 1, 3, 5, and 7 AND folinic acid 7.5 mg PO on days 2, 4, 6, and 8 (most common)
  • Preferred regimen(2): Dactinomycin 1.25 mg/m2 IV biweekly pulsed
  • Preferred regimen(3): Methotrexate 30 mg/m2 IM weekly
  • Alternative regimen(1): 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
  • Alternative regimen(2): Methotrexate 20 mg/m2 IM days 1 to 5, repeated every 14 days
  • Alternative regimen(3): Dactinomycin 12 μg/kg/day IV days 1 to 5, repeated every 2 to 3 weeks
  • Alternative regimen(4): Methotrexate 20 mg IM daily, days 1 to 5 AND dactinomycin 500 μg IV daily, days 1 to 5, repeated every 14 days
  • Alternative regimen(5): Dactinomycin 10 μg/kg/day, days 1 to 5, repeated every 2 weeks
  • Alternative regimen(6): Methotrexate 0.4 mg/kg/day IM daily on days 1 to 5, repeated after 7 days
  • Alternative regimen(7): 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

Cycles are repeated every 2 weeks (on days 15, 16, and 22) until any metastasis present at diagnosis disappear and serum beta-human chorionic gonadotropin (beta-hCG) has normalized, then the treatment is usually continued for an additional three to four cycles.

Brain metastasis

Placental Site Trophoblastic Tumor Treatment

  • Tumors confined to the uterus (Féderation Internationale de Gynécologie et d’Obstétrique [FIGO] Stage I)
  • Tumors with extrauterine spread to genital structures (FIGO stage II)
  • Metastatic tumors (FIGO stages III and IV)

References

  1. Low-Risk Gestational Trophoblastic Neoplasia (FIGO Score 0–6) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_326 Accessed on October 8, 2015
  2. High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_328 Accessed on October 8, 2015
  3. High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment. National Cancer Institute. http://www.cancer.gov/types/gestational-trophoblastic/hp/gtd-treatment-pdq/#section/_328 Accessed on October 8, 2015

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