Gestational trophoblastic neoplasia medical therapy

Template:Choriocarcinoma Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.