High-risk metastatic gestational trophoblastic neoplasia. Primary management with EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) chemotherapy.
OBJECTIVE
To describe and evaluate the clinical profile and response of patients with metastatic high-risk gestational trophoblastic neoplasia (GTN) to EMA-CO and other adjuvant treatment.


METHODS
A retrospective, descriptive analysis of data was done using charts of diagnosed cases of GTN from 2006-2010. The patients were classified according to the International Federation of Gynecology and Obstetrics anatomic staging and World Health Organization prognostic scoring. Clinical profiles of patients and response to EMA-CO chemotherapy and other surgical procedures in terms of remission rates, toxicities and mortality were evaluated.


RESULTS
Seventy-three patients had metastatic high-risk disease. Sixty-seven patients were started on EMA-CO as first-line treatment. Only 56 completed treatment. Of those 56 patients, 30% underwent adjuvant surgical therapy. Primary remission rate with EMA-CO was 72%. Sustained remission rate after chemotherapy and other adjuvant procedures was 80%. Overall survival rate was 86% at the time of this writing. Of the 8 patients who died, 5 had stage IV disease while 3 had stage III disease. Factors that significantly affected response to EMA-CO were pretreatment hCG levels >100,000 mIU/mL and stage IV disease. The most common toxicities associated with the regimen were hematologic in nature.


CONCLUSIONS
The use of EMA-CO chemotherapy as primary treatment for patients with metastatic high-risk GTN resulted in a primary remission rate of 72% and sustained remission rate of 80%. A survival rate of 86% was seen in this study.
Department of Pharmacology and Toxicology and the Section of Trophoblastic Diseases, Department of Obstetrics and Gynecology, University of the Philippines Manila College of Medicine, Ermita, Manila, Philippines. faye_cagayan@hotmail.com
M Stephanie Fay S
MS
Cagayan
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D014750:Vincristine / Q000627:therapeutic use
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate