Gestational trophoblastic neoplasia medical therapy
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 IM on days 1, 3, 5, and 7) and folinic acid (7.5 mg PO 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 to 5, 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 AND folinic acid AND dactinomycin AND cyclophosphamide.
- Another MAC: Methotrexate AND dactinomycin AND chlorambucil.
- EMA: Etoposide AND methotrexate AND folinic acid AND dactinomycin (EMA/CO without the CO).
- CHAMOCA: Methotrexate AND dactinomycin AND cyclophosphamide AND doxorubicin AND melphalan AND hydroxyurea AND vincristine.
- CHAMOMA: Methotrexate AND folinic acid AND hydroxyurea AND dactinomycin AND vincristine AND melphalan AND doxorubicin.