Comparing cisplatin-based combination chemotherapy with EMA/CO chemotherapy for the treatment of high risk gestational trophoblastic neoplasia

Abstract

BackgroundCisplatin-based chemotherapy (etoposide 100mg/m2 days 1–5, methotrexate 300mg/m2 day 1, cyclophosphamide 600mg/m2 day 1, actinomycin D 0.6mg/m2 day 2 and cisplatin 60mg/m2 day 4, EMACP) was compared to EMA/CO (etoposide 100mg/m2 days 1–2, methotrexate 300mg/m2 day 1 and actinomycin D 0.5mg i.v. bolus day 1 and 0.5mg/m2 day 2, alternating with cyclophosphamide 600mg/m2 day 8 and vincristine 1mg/m2 day 8) for the treatment of high-risk gestational trophoblastic neoplasia (GTN). Patients and methodsIn 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. ResultsRemission 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. ConclusionEMACP 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.