Journal
BEST PRACTICE & RESEARCH CLINICAL OBSTETRICS & GYNAECOLOGY
Volume 74, Issue -, Pages 81-96Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.bpobgyn.2021.01.005
Keywords
Gestational trophoblastic neoplasia; Gestational trophoblastic disease; Chemotherapy; Human chorionic gonadotropin; Choriocarcinoma
Categories
Funding
- Dyett Family Trophoblastic Disease Research and Registry Endowment
- Donald P. Goldstein MD Trophoblastic Tumor Registry Endowment
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High-risk gestational trophoblastic neoplasia (GTN) patients should undergo multiagent chemotherapy, such as EMA/CO, with at least three consolidation courses of EMA-CO after remission. Chemoresistance may be present if hCG levels plateau or increase during treatment, and EMA-EP is commonly chosen for further treatment in such cases.
High-risk gestational trophoblastic neoplasia (GTN) has an increased risk of developing chemoresistance to single-agent chemotherapy; therefore, the primary treatment should be a multiagent etoposide-based regimen, preferably EMA/CO. After remission (normalization of human chorionic gonadotropin hCG), at least three consolidation courses of EMA-CO are needed to reduce the risk of relapse. Chemoresistance is diagnosed during treatment if hCG levels plateau/increase, in two consecutive values over a two-week period. When this occurs after remission, in the absence of a new pregnancy, there is a relapse. In both cases, after re-assessment of the extent of disease, EMA-EP is the most common chemotherapy choice. Even in these cases, remission rates are high. After remission is achieved, hCG should be measured monthly for a year. Pregnancy can be allowed after 12 months from remission. The follow-up of these patients in referral centers minimizes the chance of death from this disease and should be encouraged. (c) 2021 Published by Elsevier Ltd.
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