Cisplatin, vinblastine, and bleomycin combination in the treatment of resistant high-risk. Gestational trophoblastic tumors

Abstract

Eight patients with high-risk gestational trophoblastic tumors (GTT) resistant to multiagent chemotherapy were treated with the combination of cisplatin, vinblastine, and bleomycin (PVB). All patients had a metastatic disease including three patients with two metastatic sites and two patients with brain metastases. Four patients achieved complete remission (CR) with the PVB regimen (50%). Three additional patients had partial remission (PR) of whom two were converted into CR by surgery of resistant residual lesions. One patient relapsed and the remaining five patients in CR were cured (62%). A multimodal approach was necessary in most patients as five of them had hysterectomy and two patients had a whole-brain irradiation. Toxicity was mild with no treatment related deaths.

Treating gestational trophoblastic disease

“…A combination of cisplatin, vinblastine and bleomycin (PVB) has also been effective in patients with drug-resistant tumor. Gordon [90][91][92].…”

Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia

“…Matsui et al found that 5-FU in combination with ACT-D may be used as salvage therapy and induced complete remission in 9 of 11 (82%) patients with drug-resistant GTN [104]. To treat drug-resistant GTN, a combination of cisplatin, vinblastine, and bleomycin (PVB) has been studied by Gordon et al, DuBeshter et al and Azab et al who reported that complete remission was achieved in 2 of 11 patients (18%), 4 of 7 patients (57%), and 5 of 8 patients (62%), respectively [105–107]. Ifosfamide and paclitaxel are sometimes used to treat GTN; however, further studies are needed to confirm their potential role as either primary or secondary treatment agents [108, 109].…”

Role of salvage therapy in chemo resistant or recurrent high-risk gestational trophoblastic neoplasm

“…The combination of paclitaxel and carboplatin was shown in one prospective study from our institute to produce remissions in 5/8 (63%) patients 6. A wide range of regimens have been tried as salvage therapy, including (a) bleomycin, etoposide, and cisplatin,4 (b) ifosfamide, etoposide, and cisplatin,4 (c) cisplatin, vinblastine, and bleomycin,7 (d) cisplatin, etoposide, bleomycin, and adriamycin,8 (e) etoposide, ifosfamide, and cisplatin 9…”