The Efficacy of Melphalan in the Combined Chemotherapy of Malignant Trophoblastic Disease

. Steadily progressive improvement in the diagnostic and therapeutic management of malignant trophoblastic disease has occurred over the last few decades. The most important diagnostic aid is the determination of serum HCG by sensitive radioimmunoassay which allows the detection of minute amounts of the hormone and permits discrimination between LH and HCG. Therapeutic advances include the use of combinations of different cytostatic drugs which have increased the cure rate from approximately 50% to a range of 80–95% (1, 2, 3, 4, 5, 6, 7). Malignant trophoblastic disease is rare in the Scandinavian countries which effectively limits opportunities to acquire experience within individual centers. However, a series of 23 cases has been collected at the Karolinska Hospital during the last 10 years. Patients who developed resistance against methotrexate were successfully treated by a combination of an alkylating agent melphalan (Alkeran), actinomycin D and methotrexate. In some cases this modification of a triple‐therapy regimen has turned out to be life‐saving.