Gestational trophoblastic neoplasia medical therapy

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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