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

Background: Cisplatin-based chemotherapy (etoposide 100 mg/m2 days 1-5, methotrexate 300 mg/m2 day 1, cyclophosphamide 600 mg/m2 day 1, actinomycin D 0.6 mg/m2 day 2 and cisplatin 60 mg/m2 day 4, EMACP) was compared to EMA/CO (etoposide 100 mg/m2 days 1-2, methotrexate 300 mg/m2 day 1 and actinomycin D 0.5 mg i.v. bolus day 1 and 0.5 mg/m2 day 2, alternating with cyclophosphamide 600 mg/m2 day 8 and vincristine 1 mg/m2 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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