Gestational trophoblastic neoplasia

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Dewdney.jpg
Summer B. Dewdney, MD
Rush University
Chicago, IL
4 regimens on this page
4 variants on this page


Guidelines

ESMO

NCCN

Low-risk disease, all lines of therapy

Dactinomycin monotherapy

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Regimen

Study Evidence Comparator Comparative Efficacy
Osathanondh et al. 1975 Non-randomized (RT)
Osborne et al. 2011 (GOG 0174) Phase III (E) Methotrexate Seems to have superior CR rate

Chemotherapy

14-day cycles "until the βhCG assay had reached the institutional normal, or until either a rise or plateau in the βhCG level was observed"

References

  1. Osathanondh R, Goldstein DP, Pastorfide GB. Actinomycin D as the primary agent for gestational trophoblastic disease. Cancer. 1975 Sep;36(3):863-6. link to original article PubMed
  2. GOG 0174: Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, Provencher D, Scott Miller D, Covens AL, Lage JM. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Mar 1;29(7):825-31. Epub 2011 Jan 24. link to original article link to PMC article contains verified protocol PubMed

EMA-CO

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EMA-CO: Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Oncovin (Vincristine)

Regimen

Study Evidence
Newlands et al. 1991 Non-randomized (RT)

Chemotherapy

References

  1. Newlands ES, Bagshawe KD, Begent RH, Rustin GJ, Holden L. Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989. Br J Obstet Gynaecol. 1991 Jun;98(6):550-7. link to original article PubMed

Mercaptopurine & Methotrexate

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Regimen

Study Evidence
Li et al. 1958 Pilot

Note: this is of historic interest.

Chemotherapy

References

  1. Li MC, Hertz R, Bergenstal DM. Therapy of choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists. N Engl J Med. 1958 Jul 10;259(2):66-74. link to original article PubMed

Methotrexate monotherapy

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Regimen

Study Evidence Comparator Comparative Efficacy
Li et al. 1958 Pilot
Homesley et al. 1988 Phase II
Osborne et al. 2011 (GOG 0174) Phase III (C) Dactinomycin Seems to have inferior CR rate

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.

Chemotherapy

7-day cycles "until the βhCG assay had reached the institutional normal, or until either a rise or plateau in the βhCG level was observed"

References

  1. Homesley HD, Blessing JA, Rettenmaier M, Capizzi RL, Major FJ, Twiggs LB. Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Obstet Gynecol. 1988 Sep;72(3 Pt 1):413-8. link to original article PubMed
  2. GOG 0174: Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, Provencher D, Scott Miller D, Covens AL, Lage JM. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Mar 1;29(7):825-31. Epub 2011 Jan 24. link to original article link to PMC article contains verified protocol PubMed