Gestational trophoblastic neoplasia medical therapy: Difference between revisions
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Treatment commonly used treatment regimens include the following: | Treatment commonly used treatment regimens include the following: | ||
* The 8-day | * The 8-day charing cross regimen. [[Methotrexate]] (50 mg intramuscularly [IM] on days 1, 3, 5, and 7) and [[folinic acid]] (7.5 mg orally on days 2, 4, 6, and 8). This may be the most common regimen worldwide | ||
* Biweekly pulsed dactinomycin (1.25 mg/m2 IV) | * Biweekly pulsed [[dactinomycin]] (1.25 mg/m2 IV) | ||
* Weekly methotrexate (30 mg/m2 IM). Efficacy of this regimen appears to be low for choriocarcinoma and for patients with Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) risk scores of 5 to 6 | * Weekly methotrexate (30 mg/m2 IM). Efficacy of this regimen appears to be low for choriocarcinoma and for patients with Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) risk scores of 5 to 6 | ||
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* Dactinomycin 10 μg/kg/day, days 1 to 5, repeated every 2 weeks | * Dactinomycin 10 μg/kg/day, days 1 to 5, repeated every 2 weeks | ||
* Methotrexate 0.4 mg/kg/day IM daily on days 1 to 5, repeated after 7 days | * Methotrexate 0.4 mg/kg/day IM daily on days 1 to 5, repeated after 7 days | ||
* Etoposide 100 mg/m2/day IV on days 1 to 5, or 250 mg/m2 IV on days 1 and 3, at 10-day intervals | * [[Etoposide]] 100 mg/m2/day IV on days 1 to 5, or 250 mg/m2 IV on days 1 and 3, at 10-day intervals | ||
High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment | High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment | ||
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Examples of other regimens that have been used include the following: | Examples of other regimens that have been used include the following: | ||
MAC: Methotrexate, folinic acid, dactinomycin, and cyclophosphamide. | MAC: Methotrexate, folinic acid, dactinomycin, and [[cyclophosphamide]]. | ||
Another MAC: Methotrexate, dactinomycin, and chlorambucil. | Another MAC: Methotrexate, dactinomycin, and [[chlorambucil]]. | ||
EMA: Etoposide, methotrexate, folinic acid, and dactinomycin (EMA/CO without the CO). | EMA: Etoposide, methotrexate, folinic acid, and dactinomycin (EMA/CO without the CO). | ||
CHAMOCA: Methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine. | CHAMOCA: Methotrexate, dactinomycin, cyclophosphamide, [[doxorubicin]], [[melphalan]], hydroxyurea, and [[vincristine]]. | ||
CHAMOMA: Methotrexate, folinic acid, hydroxyurea, dactinomycin, vincristine, melphalan, and doxorubicin. | CHAMOMA: Methotrexate, folinic acid, hydroxyurea, dactinomycin, vincristine, melphalan, and doxorubicin. | ||
==References== | ==References== | ||
Revision as of 15:04, 8 October 2015
Template:Choriocarcinoma Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Chemotherapy
Low-Risk Gestational Trophoblastic Neoplasia (FIGO Score 0–6)
Treatment commonly used treatment regimens include the following:
- The 8-day charing cross regimen. Methotrexate (50 mg intramuscularly [IM] on days 1, 3, 5, and 7) and folinic acid (7.5 mg orally on days 2, 4, 6, and 8). This may be the most common regimen worldwide
- Biweekly pulsed dactinomycin (1.25 mg/m2 IV)
- Weekly methotrexate (30 mg/m2 IM). Efficacy of this regimen appears to be low for choriocarcinoma and for patients with Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) risk scores of 5 to 6
Other regimens in less-common use include the following:
- An 8-day regimen of methotrexate (1 mg/kg IM days 1, 3, 5, and 7) and folinic acid (0.1 mg/kg IM days 2, 4, 6, and 8)
- Methotrexate 20 mg/m2 IM days 1 to5, repeated every 14 days
- Dactinomycin 12 μg/kg/day IV days 1 to 5, repeated every 2 to 3 weeks
- Methotrexate 20 mg IM daily, days 1 to 5; and dactinomycin 500 μg IV daily, days 1 to 5, repeated every 14 days
- Dactinomycin 10 μg/kg/day, days 1 to 5, repeated every 2 weeks
- Methotrexate 0.4 mg/kg/day IM daily on days 1 to 5, repeated after 7 days
- Etoposide 100 mg/m2/day IV on days 1 to 5, or 250 mg/m2 IV on days 1 and 3, at 10-day intervals
High-Risk Gestational Trophoblastic Neoplasia (FIGO Score ≥7) Treatment
| Day | Drug | Dose |
| 1 | Etoposide | 100 mg/m2 IV for 30 min |
| Dactinomycin | 0.5 mg IV push | |
| Methotrexate | 300 mg/m2 IV for 12 h | |
| 2 | Etoposide | 100 mg/m2 IV for 30 min |
| Dactinomycin | 0.5 mg IV push | |
| Folinic Acid | 15 mg or PO every 12 h × 4 doses, beginning 24 h after the start of methotrexate | |
| 8 | Cyclophosphamide | 600 mg/m2 IV infusion |
| Vincristine | 0.8–1.0 mg/m2 IV push (maximum dose 2 mg |
Examples of other regimens that have been used include the following: MAC: Methotrexate, folinic acid, dactinomycin, and cyclophosphamide. Another MAC: Methotrexate, dactinomycin, and chlorambucil. EMA: Etoposide, methotrexate, folinic acid, and dactinomycin (EMA/CO without the CO). CHAMOCA: Methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine. CHAMOMA: Methotrexate, folinic acid, hydroxyurea, dactinomycin, vincristine, melphalan, and doxorubicin.