Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine for the treatment of metastatic, high-risk gestational trophoblastic disease

J. C. Schink, D. K. Singh, A. W. Rademaker, D. S. Miller, J. R. Lurain

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Objective: To evaluate the efficacy and toxicity of a regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine in patients with metastatic, high-risk gestational trophoblastic tumors. Methods: Twelve women with metastatic gestational choriocarcinoma received 64 treatment cycles. All met the National Cancer Institute criteria for high-risk gestational trophoblastic tumors. Response was evaluated by monitoring serial serum β-hCG levels. Toxicity was recorded using standard World Health Organization criteria. Results: There was no life-threatening toxicity. Neutropenia necessitating a 1-week delay of treatment occurred with only eight treatment cycles (12.5%) and deferral of vincristine and cyclophosphamide with three cycles. Anemia requiring transfusion complicated only two cycles. Peripheral neuropathy in two patients was treated by discontinuing vincristine. Other toxicities included nausea and vomiting, diarrhea, stomatitis, alopecia, conjunctivitis, thrombocytopenia, and fever. Ten of the 12 subjects experienced a complete response. Two had partial responses and one with an initial complete response had relapse 4 months after completing therapy; all three were successfully salvaged with cisplatin-based chemotherapy. Overall survival was 100%, and all 12 patients are disease-free with a median follow-up of 26 months. Conclusions: Chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine is well tolerated and highly effective for metastatic, high-risk gestational trophoblastic disease.

Original languageEnglish (US)
Pages (from-to)817-820
Number of pages4
JournalObstetrics and Gynecology
Volume80
Issue number5
StatePublished - 1992

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Gestational Trophoblastic Disease
Dactinomycin
Vincristine
Etoposide
Methotrexate
Cyclophosphamide
Trophoblastic Neoplasms
Drug Therapy
Stomatitis
Choriocarcinoma
Conjunctivitis
National Cancer Institute (U.S.)
Alopecia
Peripheral Nervous System Diseases
Therapeutics
Neutropenia
Thrombocytopenia
Nausea
Cisplatin
Vomiting

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine for the treatment of metastatic, high-risk gestational trophoblastic disease. / Schink, J. C.; Singh, D. K.; Rademaker, A. W.; Miller, D. S.; Lurain, J. R.

In: Obstetrics and Gynecology, Vol. 80, No. 5, 1992, p. 817-820.

Research output: Contribution to journalArticle

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abstract = "Objective: To evaluate the efficacy and toxicity of a regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine in patients with metastatic, high-risk gestational trophoblastic tumors. Methods: Twelve women with metastatic gestational choriocarcinoma received 64 treatment cycles. All met the National Cancer Institute criteria for high-risk gestational trophoblastic tumors. Response was evaluated by monitoring serial serum β-hCG levels. Toxicity was recorded using standard World Health Organization criteria. Results: There was no life-threatening toxicity. Neutropenia necessitating a 1-week delay of treatment occurred with only eight treatment cycles (12.5{\%}) and deferral of vincristine and cyclophosphamide with three cycles. Anemia requiring transfusion complicated only two cycles. Peripheral neuropathy in two patients was treated by discontinuing vincristine. Other toxicities included nausea and vomiting, diarrhea, stomatitis, alopecia, conjunctivitis, thrombocytopenia, and fever. Ten of the 12 subjects experienced a complete response. Two had partial responses and one with an initial complete response had relapse 4 months after completing therapy; all three were successfully salvaged with cisplatin-based chemotherapy. Overall survival was 100{\%}, and all 12 patients are disease-free with a median follow-up of 26 months. Conclusions: Chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine is well tolerated and highly effective for metastatic, high-risk gestational trophoblastic disease.",
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AU - Lurain, J. R.

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N2 - Objective: To evaluate the efficacy and toxicity of a regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine in patients with metastatic, high-risk gestational trophoblastic tumors. Methods: Twelve women with metastatic gestational choriocarcinoma received 64 treatment cycles. All met the National Cancer Institute criteria for high-risk gestational trophoblastic tumors. Response was evaluated by monitoring serial serum β-hCG levels. Toxicity was recorded using standard World Health Organization criteria. Results: There was no life-threatening toxicity. Neutropenia necessitating a 1-week delay of treatment occurred with only eight treatment cycles (12.5%) and deferral of vincristine and cyclophosphamide with three cycles. Anemia requiring transfusion complicated only two cycles. Peripheral neuropathy in two patients was treated by discontinuing vincristine. Other toxicities included nausea and vomiting, diarrhea, stomatitis, alopecia, conjunctivitis, thrombocytopenia, and fever. Ten of the 12 subjects experienced a complete response. Two had partial responses and one with an initial complete response had relapse 4 months after completing therapy; all three were successfully salvaged with cisplatin-based chemotherapy. Overall survival was 100%, and all 12 patients are disease-free with a median follow-up of 26 months. Conclusions: Chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine is well tolerated and highly effective for metastatic, high-risk gestational trophoblastic disease.

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