Gestational Trophoblastic Disease 5 Flashcards

Describe treatment options for gestational trophoblast neoplasia based on stage and risk assessment.

1
Q

What are indications for treatment of postmolar trophoblastic neoplasia?

A
  • Plateauing hCG levels x 4 values over 3 weeks
  • Rising hCG levels > 10% x 3 values over 2 weeks
  • Persistently elevated hCG levels 6 months after evacuation
  • Histopathologic diagnosis of choriocarcinoma
  • Detection of metastases
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2
Q

What is involved in the treatment of low-risk GTN?

A
  • Methotrexate given 0.4mg/kg (max 25mg)IV push qd x 5 days qo week is an effective regimen as first-line treatment of FIGO low-risk GTN, resulting in a complete response rate of 81% with limited toxicity
  • Most patients resistant to initial chemotherapy will be placed into remission with additional single-agent chemotherapy, yielding an overall complete response rate of 94%•
  • Presence of metastasis, clinicopathologic diagnosis of choriocarcinoma and increasing FIGO score are associated with resistance to initial single-agent therapy
  • Multiagent chemotherapy was required for only 6% of patients who failed sequential single-agent therapy
  • Patients with low-risk GTN, if treated appropriately, should have 100% survival rate
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3
Q

What is the treatment for high-risk metastatic gestational trophoblastic neoplasia?

A
  • Chemotherapy
    • MAC
    • CHAMOCA
    • EMA-CO
    • BEP, VIP, ICE, TP/TE
  • Radiotherapy – brain
  • Surgery
    • Adjuvant
    • Excision of foci of resistant disease
    • Treat infection or bleeding
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4
Q

What is the treatment of metastatic gestational trophoblastic neoplasia?

A
  • EMA-CO should be the treatment of choice for patients with high-risk GTN
  • 30-40% of high-risk patients will fail first-line therapy or relapse from remission
  • Most of these patients with have a clinicopathologic diagnosis of choriocarcinoma, a large tumor burden reflected by a high hCG level, multiple metastases to sites other than the lung and pelvis, and very high FIGO scores
  • Salvage chemotherapy with platinum/etoposide-containing drug regimens + bleomycin, ifosfamide or paclitaxel, often combined with surgical resection of sites of persistent tumor (usually in the uterus or lungs), will result in cure rates approaching 90%
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