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Gestational trophoblastic tumors are rare but highly curable cancers that develop from the products in the uterus (or womb) after conception of the sperm and egg. Some women with gestational trophoblastic tumors (GTT) can be cured with surgery, while others need chemotherapy. Most women who need chemotherapy (95 to 97%) are cured; however, a few may have resistant or recurrent (returning) disease and need additional treatment. Now, researchers in England report that an intensive chemotherapy regimen of etoposide, cisplatin/etoposide, methotrexate, and actinomycin D is effective for women with GTT for whom previous chemotherapy has failed.

There are 2 types of gestational trophoblastic tumors:

hydatiform mole and choriocarcinoma. GTT of the hydatiform mole type develops when a sperm and egg are joined without development of a baby. Cancerous tissue begins to grow in the uterus, but does not spread beyond the uterus. Choriocarcinoma grows from the tissue that is left in the uterus after an abortion or the delivery of a baby. This type of cancer can spread outside the uterus, to other parts of the body. One such type of GTT is placental-site trophoblastic disease, which develops where the placenta attaches to the uterus. A hormone called beta human chorionic gonadotropin (HCG) is present during a normal pregnancy; however, it is not present after pregnancy. If HCG is found in the blood after a pregnancy, GTT may be suspected. Depending on the level of HCG, specific type of GTT, and stage of disease (extent of disease at diagnosis), some women may be at low risk for spread of the cancer, while others are at high risk. For those at low risk, a chemotherapy regimen of methotrexate and folinic acid is often effective. For those at high risk, a chemotherapy regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACV) is often used with great success. Researchers continue to study other treatments to fight the rare GTT for which the initial chemotherapy regimen does not result in a cure.

Researchers in England treated 34 women with high-risk GTT, plus 8 more with placental-site trophoblastic disease, for whom initial chemotherapy with EMACV had failed. These women received a second, more intensive chemotherapy regimen with etoposide, cisplatin/etoposide, methotrexate, and actinomycin D (EMA). The results showed that 88% of the 34 women with GTT were cured and free of cancer, while 4 of the 8 women with placenta-site trophoblastic disease specifically were cured and free of cancer. Cure in women with placenta-site trophoblastic disease whose pregnancy had been recent (within 2 years) was 100%. The intensive EMA chemotherapy regimen appeared to be effective, although side effects, primarily low blood counts, were significant.

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The researchers concluded that the intensive EMA chemotherapy regimen is effective for the majority of women with GTT for whom initial treatment has failed, but requires attention to potential side effects, such as low blood counts. Persons who have a GTT that is resistant to or recurs after initial chemotherapy may wish to talk with their doctor about the risks and benefits of the EMA chemotherapy regimen, or of participating in a clinical trial in which other new treatments are being studied.

(Journal of Clinical Oncology, Vol 18, No 4, pp 854-859, 2000).