THE MANAGEMENT OF GESTATIONAL TROPHOBLASTIC TUMORS WITH ETOPOSIDE, METHOTREXATE, AND ACTINOMYCIN-D

Objective: To evaluate the efficacy and safety of etoposide, methotrex ate, and actinomycin D (EMA) as primary and secondary therapy for gest ational trophoblastic tumor (GTT). Methods: In a retrospective study, the medical records of all patients with middle-risk metastatic GTT or nonmetastatic choriocarcinoma receiving primary EMA and patients with GTT resistant to single-agent regimens treated with secondary EMA wer e reviewed. Hematologic toxicity was graded using WHO criteria. Result s: Seven patients received primary EMA with 5 (67%) achieving remissio n. Twenty-two patients with resistance to single-agent regimens receiv ed secondary EMA with 21 (95%) achieving remission. The most acute hem atologic toxicity was grade 1 or 2. Only 2 of 90 EMA cycles were assoc iated with grade 4 toxicity requiring hospital admission, Conclusion: Although EMA effectively induces remission with minimal acute hematolo gic toxicity in the primary and secondary therapy of GTT, recently pub lished data regarding secondary tumors associated with etoposide expos ure should restrict its use to patients who absolutely require etoposi de to achieve remission. (C) 1997 Academic Press