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Relapsed or refractory gestational trophoblastic neoplasia treated with the etoposide and cisplatin/etoposide, methotrexate, and actinomycin D (EP‐EMA) regimen
Author(s) -
Mao Yuyan,
Wan Xiaoyun,
Lv Weiguo,
Xie Xing
Publication year - 2007
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2007.03.037
Subject(s) - regimen , etoposide , medicine , methotrexate , vincristine , gastroenterology , refractory (planetary science) , chemotherapy , gestational trophoblastic neoplasia , chorioepithelioma , cyclophosphamide , surgery , choriocarcinoma , astrobiology , physics
Objective To evaluate the effectiveness of the etoposide and cisplatin/etoposide, methotrexate and actinomycin D (EP‐EMA) regimen in patients with gestational trophoblastic neoplasia who had been successfully treated with the etoposide, methotrexate, and actinomycin D/cyclophosphamide and vincristine (EMA‐CO) regimen but experienced a relapse, or who became refractory to EMA−CO treatment. Methods From January 1999 to December 2005, 18 patients with gestational trophoblastic neoplasia who had been successfully treated with the EMA‐CO regimen but sustained a relapse ( n = 7) or who became refractory to it ( n = 11) were treated with the EP‐EMA regimen. The effectiveness, adverse effects, and tolerated dose intensity of the EP‐EMA regimen were retrospectively analyzed. Results The 18 patients received a total of 74 cycles of the EP‐EMA regimen and 12 (66.7%) achieved complete remission. Nine of the 11 patients (81.8%) apparently resistant to the EMA‐CO regimen achieved complete remission. However, only 3 of the 7 patients (42.9%) who experienced a relapse after treatment with the EMA‐CO regimen achieved complete remission. The main adverse effects of the EP‐EMA regimen were myelosuppression and gastrointestinal problems. Because of myelosuppression and hepatotoxicity, only 56.8% of the patients could be treated with the planned dose intensity. Conclusion EP‐EMA may be an effective option for the treatment of gestational trophoblastic neoplasia in patients resistant to treatment with the EMA‐CO regimen. However, it does not seem to benefit all the patients who experienced a relapse after treatment with the EMA‐CO regimen.