Gestational trophoblastic neoplasia medical therapy

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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.

References

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