title: Remission of refractory gestational trophoblastic disease with high-dose paclitaxel.
abstract: High-risk metastatic gestational trophoblastic disease (GTD) in patients who have failed primary chemotherapy has a very poor prognosis. About 25% of women with high-risk metastatic disease become refractory to EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine) and fall to achieve a complete remission. Currently, there is no standard salvage chemotherapeutic regime for EMA-CO failure. Paclitaxel, a taxane analog extracted from the bark of the western yew (Taxus brevlfolla), has shown antitumor activity in a variety of cancer cell lines. High in vivo efficacy was confirmed in phase II trials, especially for breast and epithelial ovarian cancer patients. Recently, two in vitro studies have shown that paclitaxel is a highly effective antineoplastic agent in choriocarcinoma cell lines. We present the first clinical report of a serologic remission with high-dose paclitaxel (250 mg/m2 i.v. infusion over 24 h every 3 weeks) of a highly refractory GTD in a patient who developed brain metastasis after multiple combined chemotherapeutic regimens. The patient tolerated paclitaxel with granulocyte colony stimulating factor support very well. The remission with paclitaxel in this patient confirms its preclinical activity in high-risk, refractory GTD.
authors.affiliation: Chulalongkorn University Hospital, Bangkok, Thailand.
authors.forename: W
authors.initials: W
authors.lastname: Termrungruanglert
authors.forename: A P
authors.initials: AP
authors.lastname: Kudelka
authors.forename: S
authors.initials: S
authors.lastname: Piamsomboon
authors.forename: C F
authors.initials: CF
authors.lastname: Verschraegen
authors.forename: C L
authors.initials: CL
authors.lastname: Edwards
authors.forename: S
authors.initials: S
authors.lastname: Lifshitz
authors.forename: R P
authors.initials: RP
authors.lastname: Mante
authors.forename: J J
authors.initials: JJ
authors.lastname: Kavanagh
mesh_terms: D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000556:secondary; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D017239:Paclitaxel / Q000627:therapeutic use*; D011247:Pregnancy; D012074:Remission Induction; D014328:Trophoblastic Neoplasms / Q000097:blood / Q000188:drug therapy*; D014594:Uterine Neoplasms / Q000097:blood / Q000188:drug therapy*
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D018997:Chorionic Gonadotropin, beta Subunit, Human; D016179:Granulocyte Colony-Stimulating Factor; D017239:Paclitaxel