Comparing cisplatin-based combination chemotherapy with EMA/CO chemotherapy for the treatment of high risk gestational trophoblastic neoplasia
Publication year
2013Source
European Journal of Cancer, 49, 4, (2013), pp. 860-7ISSN
Publication type
Article / Letter to editor

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Organization
Gynaecology
Laboratory of Genetic, Endocrine and Metabolic Diseases
Medical Oncology
IQ Healthcare
Journal title
European Journal of Cancer
Volume
vol. 49
Issue
iss. 4
Page start
p. 860
Page end
p. 7
Subject
IGMD 6: Hormonal regulation ONCOL 5: Aetiology, screening and detection; NCEBP 4: Quality of hospital and integrated care; ONCOL 1: Hereditary cancer and cancer-related syndromes; ONCOL 3: Translational research; ONCOL 4: Quality of Care NCEBP 4: Quality of hospital and integrated care; ONCOL 5: Aetiology, screening and detection NCMLS 2: Immune RegulationAbstract
BACKGROUND: Cisplatin-based chemotherapy (etoposide 100mg/m(2) days 1-5, methotrexate 300mg/m(2) day 1, cyclophosphamide 600mg/m(2) day 1, actinomycin D 0.6mg/m(2) day 2 and cisplatin 60mg/m(2) day 4, EMACP) was compared to EMA/CO (etoposide 100mg/m(2) days 1-2, methotrexate 300mg/m(2) day 1 and actinomycin D 0.5mg i.v. bolus day 1 and 0.5mg/m(2) day 2, alternating with cyclophosphamide 600mg/m(2) day 8 and vincristine 1mg/m(2) day 8) for the treatment of high-risk gestational trophoblastic neoplasia (GTN). PATIENTS AND METHODS: In the Netherlands, 83 patients were treated with EMACP and 103 patients with EMA/CO. Outcome measures were remission rate, median number of courses to achieve normal human chorionic gonadotrophin (hCG) concentrations, toxicity, recurrent disease rate and disease specific survival. RESULTS: Remission rates were similar (EMACP 91.6%, EMA/CO 85.4%). The median number of courses of EMA/CO to reach hCG normalisation for single-agent resistant disease and primary high-risk disease was three and five courses, respectively, compared to 1.5 (p=0.001) and three (p<0.001) courses of EMACP. Patients treated with EMACP more often developed fever, renal toxicity, nausea and diarrhoea compared to patients treated with EMA/CO. Patients treated with EMA/CO more often had anaemia, neuropathy and hepatotoxicity. CONCLUSION: EMACP combination chemotherapy is an effective treatment for high-risk GTN, with a remission rate comparable to EMA/CO. However, the difference in duration of treatment is only slightly shorter with EMACP. Cisplatin-based chemotherapy in the form of EMACP in this study was not proven more effective than EMA/CO.
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- Faculty of Medical Sciences [89012]
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