Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989.
OBJECTIVE
To assess the efficacy, toxicity and survival in patients with high risk GTT treated with the EMA/CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine/oncovine).


METHODS
Open non-randomized study of 148 consecutive patients referred to the Charing Cross Hospital between 1979 and 1989.


METHODS
Trophoblastic disease centre in a London teaching hospital.


METHODS
148 consecutive patients with high risk GTT were treated with the EMA/CO regimen. 76 patients had received no prior chemotherapy and 72 had received prior chemotherapy.


METHODS
Survival, causes of treatment failure and toxicity were analysed.


RESULTS
Of 76 patients who had received no prior chemotherapy, 62 (82%) are in remission; an overall survival of 85% for the 148 patients. Ten of the 76 patients without prior chemotherapy died from extensive disease within 3 weeks of starting chemotherapy. The complete and partial response rates to EMA/CO chemotherapy were 80% and 18% respectively. The addition of cisplatin salvaged 9 of 11 (82%) who developed drug resistance and did not require surgery. Salvage surgery alone resulted in 7 of 8 (87%) having complete remissions. Relapse after EMA/CO chemotherapy is uncommon (5.4%) but survival is still relatively good with further chemotherapy and/or surgery with 6 (75%) of 8 patients obtaining a further sustained remission. Complications from EMA/CO chemotherapy are acceptable with myelosuppression being dose-limiting. Late sequelae are uncommon: menstruation usually returns with a few months, and no fetal abnormalities have been recorded in subsequent pregnancies. One patient developed what we presume to be a therapy-induced acute myeloid leukaemia.


CONCLUSIONS
At present EMA/CO chemotherapy is our treatment of choice for patients with high risk GTT. Its toxicity is predictable and reversible. In patients developing drug resistance, salvage surgery is important. Future developments may include further dose intensification with the addition of haemopoietic growth factors, earlier diagnosis and the separation of gestational from non-gestational trophoblastic tumours.
Newlands
E S
ES
Department of Medical Oncology, Charing Cross Hospital, London.
Bagshawe
K D
KD
Begent
R H
RH
Rustin
G J
GJ
Holden
L
L
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002423:Cause of Death; D003131:Combined Modality Therapy; D003399:Craniotomy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003609:Dactinomycin / Q000009:adverse effects / Q000627:therapeutic use; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D015996:Survival Rate; D013908:Thoracotomy; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate