title: A novel strategy using G-CSF to support EMA/CO for high-risk gestational trophoblastic disease.
abstract: EMA/CO (etoposide-methotrexate-actinomycin D and Cytoxan-Oncovin) is an effective and well-tolerated chemotherapy regimen for the treatment of high-risk gestational trophoblastic disease. However, it is associated with significant neutropenia often requiring dose reductions and treatment delays. We describe the use of granulocyte colony-stimulating factor (G-CSF) in three patients in order to maintain the treatment schedule. A subcutaneous injection of 5 micrograms/kg/day was administered on Days 3-6 and 9-14 of each chemotherapy cycle. No patients had any adverse effects and all received full chemotherapy doses without any treatment delay. The addition of G-CSF to the EMA/CO regimen may benefit patients by achieving dose intensity in the treatment of high-risk gestational trophoblastic disease.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Cancer Center, University of Minnesota, Minneapolis 55455.
authors.forename: E M
authors.initials: EM
authors.lastname: Hartenbach
authors.forename: A K
authors.initials: AK
authors.lastname: Saltzman
authors.forename: J R
authors.initials: JR
authors.lastname: Carter
authors.forename: L B
authors.initials: LB
authors.lastname: Twiggs
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002822:Choriocarcinoma / Q000188:drug therapy / Q000628:therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000628:therapy; D018245:Trophoblastic Tumor, Placental Site / Q000188:drug therapy / Q000628:therapy; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000628:therapy; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate