REMISSION OF REFRACTORY GESTATIONAL TROPHOBLASTIC DISEASE WITH HIGH-DOSE PACLITAXEL

High-risk metastatic gestational trophoblastic disease (GTD) in patien ts who have failed primary chemotherapy has a very poor prognosis. Abo ut 25% of women with high-risk metastatic disease become refractory to EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide and vincristine) and fail to achieve a complete remission. Currently, ther e is no standard salvage chemotherapeutic regime for EMA-CO failure. P aclitaxel, a taxane analog extracted from the bark of the western yew (Taxus brevifolia), has shown antitumor activity in a variety of cance r cell lines. High in vivo efficacy was confirmed in phase II trials, especially for breast and epithelial ovarian cancer patients. Recently , two in vitro studies have shown that paclitaxel is a highly effectiv e antineoplastic agent in choriocarcinoma cell lines. We present the f irst clinical report of a serologic remission with high-dose paclitaxe l (250 mg/m(2) i.v. infusion over 24 h every 3 weeks) of a highly refr actory GTD in a patient who developed brain metastasis after multiple combined chemotherapeutic regimens. The patient tolerated paclitaxel w ith granulocyte colony stimulating factor support very well. The remis sion with paclitaxel in this patient confirms its preclinical activity in high-risk, refractory GTD.