Etoposide, cisplatin–etoposide, methotrexate, actinomycin‐D as primary treatment for management of very‐high‐risk gestational trophoblastic neoplasia

Cyriac, Sanju; Rajendranath, Rejiv; Sridevi, V.; Sagar, Tenali Gnana

doi:10.1016/j.ijgo.2011.04.017

Cited by 22 publications

(8 citation statements)

References 15 publications

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“…• EMA/EP (etoposide, methotrexate, dactinomycin alternating with etoposide and cisplatin) 65,66 or EP/ EMA (etoposide and cisplatin alternating with etoposide, methotrexate, and dactinomycin) 67 • MEA (methotrexate, etoposide, dactinomycin) 68 • MAC (methotrexate, dactinomycin, and chlorambucil) 69 • FA (5-FU and dactinomycin) 70 • MEF (methotrexate, etoposide, and 5-FU) 71 • CHAMOCA (methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine) 69 Due to the lack of RCTs in this setting, systematic reviews have been unable to draw conclusions regarding a superior combination regimen for primary treatment of high-risk GTN. 46,72 EMA/EP (or EP/EMA) is highly active and considered by some to be superior to EMA/CO for ultra-high-risk disease; however, its use as standard initial therapy is limited by increased toxicity and inability to provide adequate salvage chemotherapy if required for persistent/recurrent disease.…”

Section: High-risk Gtnmentioning

confidence: 99%

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Abu‐Rustum

Yashar

Bean

et al. 2019

Journal of the National Comprehensive Cancer Network

100

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Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor.

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Section: High-risk Gtnmentioning

confidence: 99%

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Abu‐Rustum

Yashar

Bean

et al. 2019

Journal of the National Comprehensive Cancer Network

100

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“…The overall cure rate was 96.4%, with a mortality of 0.4% for low-risk disease, 9.5% for high-risk and 21.4% for PSTT 7 . Methotrexate (MTX), actinomycin-D (ActD), cyclophosphamide, vincristine, etoposide, cisplatin and paclitaxel are some of the drugs used to treat GTN effectively 19 . After hCG returns to normal levels, additional ChT courses, called consolidation ChT, are repeated three to four times, especially in cases of high-risk disease, to avoid recurrence 20 .…”

Section: Treatmentmentioning

confidence: 99%

Diagnosis, classification and treatment of gestational trophoblastic neoplasia

Biscaro¹,

Braga²,

Berkowitz³

2015

Rev. Bras. Ginecol. Obstet.

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Gestational trophoblastic neoplasia (GTN) is the term to describe a set of malignant placental diseases, including invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Both invasive mole and choriocarcinoma respond well to chemotherapy, and cure rates are greater than 90%. Since the advent of chemotherapy, low-risk GTN has been treated with a single agent, usually methotrexate or actinomycin D. Cases of high-risk GTN, however, should be treated with multiagent chemotherapy, and the regimen usually selected is EMA-CO, which combines etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine. This study reviews the literature about GTN to discuss current knowledge about its diagnosis and treatment. ResumoNeoplasia trofoblástica gestacional (NTG) é o termo que descreve o conjunto de anomalias malignas da placenta, incluindo a mola invasora, coriocarcinoma, tumor trofoblástico do sítio placentário e tumor trofoblástico epitelióide. Ambos a mola invasora e o coriocarcinoma respondem bem à quimioterapia, com taxas de cura superiores a 90%. Desde o advento da quimioterapia, NTG de baixo risco tem sido tratada com monoquimioterapia, pelo geral methotrexate ou actinomicina-D. Casos de NTG de alto risco, contudo, devem ser tratados com poliquimioterapia, e o regime usualmente escolhido é o EMA-CO que combina etoposide, methotrexate, actinomicina-D, ciclofosfamida e vincristina. Esse estudo revê a literatura sobre NTG a fim de discutir os conhecimentos atuais sobre seu diagnóstico e tratamento.

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“…Type of GTN pathology was unknown in most patients ( Table 2 ). Uterine mass was detected in 16 of 20 patients (84%), and tumor size was less the 5 cm in 52% of the cases ( 11 ). Four patients underwent hysterectomy, of which 3 had the tumor size of greater than 5 cm.…”

Section: Resultsmentioning

confidence: 99%

“…Due to the higher response rate of EMA/EP, compared to EMA/CO, some authors have suggested EMA/EP as the first- line chemotherapy regimen ( 11 ). EMA/EP has been used as a good salvage treatment with a survival rate of up to 84.9% ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Outcome of treatment with EMA/EP (etoposide methotrexate and actinomycin-D/ etoposide and cisplatin) regimen in gestational trophoblastic neoplasia

Aminimoghaddam

Nezhadisalami

Anjidani

et al. 2018

Med. J. Islam. Republic Iran

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Background: Gestational trophoblastic neoplasia (GTN) originates from placental trophoblast and is a highly chemosensitive and curable gynecologic malignancy. The present study was conducted to evaluate the effectiveness and safety of EMA/EP (etoposide, methotrexate, actinomycin-D, etoposide, and cisplatin) regimen in the treatment of high-risk GTN as well as patients’ outcome. Methods: Hospital charts of all patients with confirmed diagnosis of high-risk GTN who received EMA/EP regimen treatment during a 12-year period (2001-2012) at the tertiary center of comprehensive women's hospital in Tehran, Iran, were reviewed from 2012 to 2013, retrospectively. Results: In this study, 25 patients with GTN who were treated with EMA/EP regimen during the study were identified. Complete remission rate in GTN patients with failure of single agent chemotherapy who were treated with EMA/EP regimen, as the first- line treatment, was 100%, while it was 81% in those with primary high-risk GTN. Overall remission rate in high-risk GTN patients treated with EMA/EP regimen was 88%. Anemia (92%) and leucopenia (72%) were the most common adverse effects of EMA/EP chemotherapy regimen. Acute myeloid leukemia (AML) and mortality, as the most severe adverse effects of EMA/EP regimen, were seen only in 1 patient. Conclusion: According to the results, EMA/EP regimen could induce complete remission in 88% of patients with high-risk GTN. Application of EMA/EP is recommended as the first- line therapy in patients with failure of single agent chemotherapy. However, proper care should be considered to prevent and reduce EMA/EP hematologic toxicity.

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Etoposide, cisplatin–etoposide, methotrexate, actinomycin‐D as primary treatment for management of very‐high‐risk gestational trophoblastic neoplasia

Abstract: EP-EMA was highly effective for the primary management of very-high-risk GTN.

Cited by 22 publications

References 15 publications

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Diagnosis, classification and treatment of gestational trophoblastic neoplasia

Outcome of treatment with EMA/EP (etoposide methotrexate and actinomycin-D/ etoposide and cisplatin) regimen in gestational trophoblastic neoplasia

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