Single agent etoposide in gestational trophoblastic tumours

Etoposide (VP-16) as first-line, single agentchemotherapeutic drug in low-risk gestational trophoblastic disease

“…Manyinvestigators haverecently modified the conventional protocols and several different regimenshave been reported for the treatment of low‐risk GTD, including five‐dayintramuscular MTX every two weeks(1,2,10). eight‐day alternating intramuscular MTX‐folic acid every two weeks(4,5,11); weekly escalatedintramuscular MTX(6,12); high‐doseintravenous MTX(13); Act‐D five days intravenously every two weeks(3); Act‐D pulse dose intravenously every two weeks(7); and etoposide treatment(14–16). Completeresponse rates with these various regimens have ranged from 60 to 98%,and virtually all treatment failures have been successfully salvaged with othersingle or combination chemotherapies.…”

“…Although Hitchins et al. (15) have reported relatively low primary remissionrates (69%) with single‐agent etoposidetreatment, their study included many medium‐ and high‐risk patients. Our92% primary remission rate and 1.5% relapse rate are comparableto those reports.…”

“…Hitchins et al. (15) reported thatetoposide should be reserved for patients in whom either MTX resistance hasdeveloped, or for patients initially classified into the medium‐ and high‐riskgroups because of theknown side‐effects and the unknown long‐term potential side‐effects ofetoposide. Although long‐term toxicity is difficult to assess in our series,ovarian function is wellpreserved in younger patients and secondary malignancies have been observed inonly one case (rectal carcinoma) during 10 years.…”

Etoposide (VP-16) as first-line, single agentchemotherapeutic drug in low-risk gestational trophoblastic disease

“…Manyinvestigators haverecently modified the conventional protocols and several different regimenshave been reported for the treatment of low‐risk GTD, including five‐dayintramuscular MTX every two weeks(1,2,10). eight‐day alternating intramuscular MTX‐folic acid every two weeks(4,5,11); weekly escalatedintramuscular MTX(6,12); high‐doseintravenous MTX(13); Act‐D five days intravenously every two weeks(3); Act‐D pulse dose intravenously every two weeks(7); and etoposide treatment(14–16). Completeresponse rates with these various regimens have ranged from 60 to 98%,and virtually all treatment failures have been successfully salvaged with othersingle or combination chemotherapies.…”

“…Although Hitchins et al. (15) have reported relatively low primary remissionrates (69%) with single‐agent etoposidetreatment, their study included many medium‐ and high‐risk patients. Our92% primary remission rate and 1.5% relapse rate are comparableto those reports.…”

“…Hitchins et al. (15) reported thatetoposide should be reserved for patients in whom either MTX resistance hasdeveloped, or for patients initially classified into the medium‐ and high‐riskgroups because of theknown side‐effects and the unknown long‐term potential side‐effects ofetoposide. Although long‐term toxicity is difficult to assess in our series,ovarian function is wellpreserved in younger patients and secondary malignancies have been observed inonly one case (rectal carcinoma) during 10 years.…”

Management of gestational trophoblastic neoplasia

“…Results of a large, consecutive case series of 272 patients with up to 16 years of follow-up showed a complete remission rate of 78% using this regimen, and these results are consistent with other case series in the literature that employed EMA/CO [43]. More than two-thirds of the women who did not have a complete response or subsequently had disease recurrence could be salvaged with cisplatin-containing regimens (with or without resection of metastases), yielding a long-term cure rate of 86.2% (95% CI, 81.9%-90.5%) [39].…”

Pregnancy outcome after treatment with etoposide (VP-16) for low-risk gestational trophoblastic tumor

“…The hepatic and hematologic toxicities were mild compared to the conventional MTX and MTX‐CF regimens ( 7 , 9 ) . On the other hand, use of this drug in the primary treatment of low‐risk GTT has not been advocated because of the unknown long‐term potential side‐effects of ovarian dysfunction, impaired fertility and secondary malignancies ( 5 , 10 ) .…”

Etoposide (VP-16) as first-line, single agentchemotherapeutic drug in low-risk gestational trophoblastic disease

“…Manyinvestigators haverecently modified the conventional protocols and several different regimenshave been reported for the treatment of low‐risk GTD, including five‐dayintramuscular MTX every two weeks(1,2,10). eight‐day alternating intramuscular MTX‐folic acid every two weeks(4,5,11); weekly escalatedintramuscular MTX(6,12); high‐doseintravenous MTX(13); Act‐D five days intravenously every two weeks(3); Act‐D pulse dose intravenously every two weeks(7); and etoposide treatment(14–16). Completeresponse rates with these various regimens have ranged from 60 to 98%,and virtually all treatment failures have been successfully salvaged with othersingle or combination chemotherapies.…”

“…Although Hitchins et al. (15) have reported relatively low primary remissionrates (69%) with single‐agent etoposidetreatment, their study included many medium‐ and high‐risk patients. Our92% primary remission rate and 1.5% relapse rate are comparableto those reports.…”

“…Hitchins et al. (15) reported thatetoposide should be reserved for patients in whom either MTX resistance hasdeveloped, or for patients initially classified into the medium‐ and high‐riskgroups because of theknown side‐effects and the unknown long‐term potential side‐effects ofetoposide. Although long‐term toxicity is difficult to assess in our series,ovarian function is wellpreserved in younger patients and secondary malignancies have been observed inonly one case (rectal carcinoma) during 10 years.…”

Management of gestational trophoblastic neoplasia

“…Results of a large, consecutive case series of 272 patients with up to 16 years of follow-up showed a complete remission rate of 78% using this regimen, and these results are consistent with other case series in the literature that employed EMA/CO [43]. More than two-thirds of the women who did not have a complete response or subsequently had disease recurrence could be salvaged with cisplatin-containing regimens (with or without resection of metastases), yielding a long-term cure rate of 86.2% (95% CI, 81.9%-90.5%) [39].…”

Pregnancy outcome after treatment with etoposide (VP-16) for low-risk gestational trophoblastic tumor

“…The hepatic and hematologic toxicities were mild compared to the conventional MTX and MTX‐CF regimens ( 7 , 9 ) . On the other hand, use of this drug in the primary treatment of low‐risk GTT has not been advocated because of the unknown long‐term potential side‐effects of ovarian dysfunction, impaired fertility and secondary malignancies ( 5 , 10 ) .…”

Etoposide (VP-16) as first-line, single agentchemotherapeutic drug in low-risk gestational trophoblastic disease

“…Manyinvestigators haverecently modified the conventional protocols and several different regimenshave been reported for the treatment of low‐risk GTD, including five‐dayintramuscular MTX every two weeks(1,2,10). eight‐day alternating intramuscular MTX‐folic acid every two weeks(4,5,11); weekly escalatedintramuscular MTX(6,12); high‐doseintravenous MTX(13); Act‐D five days intravenously every two weeks(3); Act‐D pulse dose intravenously every two weeks(7); and etoposide treatment(14–16). Completeresponse rates with these various regimens have ranged from 60 to 98%,and virtually all treatment failures have been successfully salvaged with othersingle or combination chemotherapies.…”

“…Although Hitchins et al. (15) have reported relatively low primary remissionrates (69%) with single‐agent etoposidetreatment, their study included many medium‐ and high‐risk patients. Our92% primary remission rate and 1.5% relapse rate are comparableto those reports.…”

“…Hitchins et al. (15) reported thatetoposide should be reserved for patients in whom either MTX resistance hasdeveloped, or for patients initially classified into the medium‐ and high‐riskgroups because of theknown side‐effects and the unknown long‐term potential side‐effects ofetoposide. Although long‐term toxicity is difficult to assess in our series,ovarian function is wellpreserved in younger patients and secondary malignancies have been observed inonly one case (rectal carcinoma) during 10 years.…”

Management of gestational trophoblastic neoplasia

“…Results of a large, consecutive case series of 272 patients with up to 16 years of follow-up showed a complete remission rate of 78% using this regimen, and these results are consistent with other case series in the literature that employed EMA/CO [43]. More than two-thirds of the women who did not have a complete response or subsequently had disease recurrence could be salvaged with cisplatin-containing regimens (with or without resection of metastases), yielding a long-term cure rate of 86.2% (95% CI, 81.9%-90.5%) [39].…”

Pregnancy outcome after treatment with etoposide (VP-16) for low-risk gestational trophoblastic tumor

“…The hepatic and hematologic toxicities were mild compared to the conventional MTX and MTX‐CF regimens ( 7 , 9 ) . On the other hand, use of this drug in the primary treatment of low‐risk GTT has not been advocated because of the unknown long‐term potential side‐effects of ovarian dysfunction, impaired fertility and secondary malignancies ( 5 , 10 ) .…”