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
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
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
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%