Metastatic choriocarcinoma successfully treated with paclitaxel and carboplatin after interstitial lung disease induced by EMA-CO.
BACKGROUND
Well-established first-line chemotherapy (such as EMA-CO) is extraordinary active for gestational choriocarcinoma. However, it causes very serious situation once drug-induced acute interstitial lung disease occurs during the treatment.


METHODS
A 31-year-old Japanese woman with metastatic choriocarcinoma was treated with EMA-CO as an initial chemotherapy regimen for seven cycles. Her beta-hCG dropped from 13,087 ng/ml to 2.2 ng/ml. At 11 days after 7th cycle of EMA-CO treatment, however, she developed respiratory failure, and was diagnosed as having EMA-CO-induced interstitial lung disease with bilateral ground-glass opacity on CT scan, and the examination of the bronchoalveolar lavage fluid. After high-dose steroid therapy, symptoms and ground-glass opacity on CT scan were remarkably improved. She then commenced a regimen of carboplatin (AUC 5) and paclitaxel (180 mg/m2). After completing 8 cycles, her beta-hCG dropped to <0.2 ng/ml. Three additional cycles were administered and the patient remained clinically free of disease, with normal beta-hCG levels for 11 months.


CONCLUSIONS
Paclitaxel and carboplatin combination is active and appears to be a viable alternative to EMA-CO combination chemotherapy in metastatic choriocarcinoma even after EMA-CO-induced interstitial lung disease.
Amikura
Takayuki
T
Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi dori Niigata 951-8510, Japan.
Aoki
Yoichi
Y
Banzai
Chiaki
C
Yokoo
Tomokazu
T
Nishikawa
Nobumichi
N
Sekine
Masayuki
M
Suzuki
Mina
M
Tanaka
Kenichi
K
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016190:Carboplatin / Q000627:therapeutic use*; D002822:Choriocarcinoma / Q000188:drug therapy* / Q000556:secondary*; D003520:Cyclophosphamide / Q000009:adverse effects; D003609:Dactinomycin / Q000009:adverse effects; D005047:Etoposide / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D017563:Lung Diseases, Interstitial / Q000139:chemically induced*; D008175:Lung Neoplasms / Q000556:secondary; D008727:Methotrexate / Q000009:adverse effects; D017239:Paclitaxel / Q000627:therapeutic use*; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology; D014750:Vincristine / Q000009:adverse effects
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin; D017239:Paclitaxel; D008727:Methotrexate