title: Remission of refractory gestational trophoblastic disease in the brain with ifosfamide, carboplatin, and etoposide (ICE): first report and review of literature.
abstract: Gestational trophoblastic disease (GTD) metastatic to the brain has a very poor prognosis with a survival rate of less than 25%, especially for patients in whom brain metastases develop while on or after chemotherapy. Cure can be achieved by chemotherapy alone. The regimen of etoposide, methotrexate, actinomycin-D, vincristine, and cyclophosphamide has shown encouraging results and is considered to be standard first-line treatment for high risk patients. For patients in whom this regimen fails, a salvage chemotherapy regimen is used. The combination of ifosfamide, carboplatin, and etoposide (ICE) has synergistic activity in preclinical studies. This regimen has shown activity in metastatic breast cancer and non-small-cell lung cancer as well as platinum-resistant germ-cell tumors and metastatic GTD. This is the first report of a patient with a highly refractory GTD in whom brain metastasis developed while on chemotherapy, and whose brain metastasis went into remission with a low dose ICE regimen. Accordingly, ICE may be considered for patients with chemotherapy refractory GTD metastatic to the brain.
authors.affiliation: Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Piamsomboon
authors.forename: A P
authors.initials: AP
authors.lastname: Kudelka
authors.forename: W
authors.initials: W
authors.lastname: Termrungruanglert
authors.forename: K
authors.initials: K
authors.lastname: Van Besien
authors.forename: C L
authors.initials: CL
authors.lastname: Edwards
authors.forename: S
authors.initials: S
authors.lastname: Lifshitz
authors.forename: D F
authors.initials: DF
authors.lastname: Schomer
authors.forename: R
authors.initials: R
authors.lastname: Champlin
authors.forename: R P
authors.initials: RP
authors.lastname: Mante
authors.forename: J J
authors.initials: JJ
authors.lastname: Kavanagh
authors.forename: C F
authors.initials: CF
authors.lastname: Verschraegen
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D002945:Cisplatin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D011247:Pregnancy; D012074:Remission Induction; D014328:Trophoblastic Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide