High-dose chemotherapy and peripheral blood stem cell support in refractory gestational trophoblastic neoplasia

El-Helw, L.; Seckl, Michael J.; Haynes, R.; Evans, Linda; Lorigan, Paul; Long, Jeremy; Kanfer, Edward; Newlands, E. S.; Hancock, Barry W.

doi:10.1038/sj.bjc.6602771

Cited by 43 publications

(12 citation statements)

References 9 publications

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“…After excluding male cases or non-gestational choriocarcinoma, our search yielded 21 cases in 11 articles between 1991 and 2013 (Table II) (7,8,(10)(11)(12)(13)(14)(15)(16)(17)(18). Two cases reported by Jean-Pierre Lotz in 1991 (11) were included in the 5 cases reported in 1995 by the same author (8).…”

Section: Hdc Diagnosis ----------------------------------------------mentioning

confidence: 99%

High-dose chemotherapy with autologous peripheral blood stem cell transplantation for choriocarcinoma: A case report and literature review

Yamamoto

Niimi

Fujikake

et al. 2016

Molecular and Clinical Oncology

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Abstract. Choriocarcinoma is a malignant gestational trophoblastic neoplasia (GTN) and one of the curable types of gynecological cancer. However, 10% of choriocarcinoma patients have a poor prognosis, particularly when they have metastasis, apart from pulmonary metastasis, or do not go into remission by the second chemotherapeutic regimen. We herein present the case of a 36-year-old patient who had choriocarcinoma with metastases to the lungs, liver and kidneys. The 5th and 6th regimens with cisplatin for choriocarcinoma failed and the patient developed brain metastases. She was then treated with four cycles of high-dose ifosfamide, carboplatin and etoposide (ICE) with blood progenitor cell support after confirming the effectiveness of ICE at normal doses. The serum human chorionic gonadotropin (hCG) level was 140,009 mIU/ml at the start of high-dose ICE and the patient tolerated this regimen well. However, the beneficial effect was decreasing with each successive course of treatment, with the lowest level of hCG at 103 mIU/ml after the fourth course. The patient did not achieve complete remission and succumbed to the disease 4 months after the last chemotherapy. The findings of the present case and a review of the related literature suggest that high-dose ICE with stem cell rescue may be considered as a viable treatment option for a multi-drug resistant choriocarcinoma or GTN.

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Section: Hdc Diagnosis ----------------------------------------------mentioning

confidence: 99%

High-dose chemotherapy with autologous peripheral blood stem cell transplantation for choriocarcinoma: A case report and literature review

Yamamoto

Niimi

Fujikake

et al. 2016

Molecular and Clinical Oncology

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“…Other drugs showing activity include 5‐fluorouracil, campothecins, and gemcitabine, but further testing is needed (23,34,52) . It is possible that high‐dose combination chemotherapy with stem cell support will prove effective against the few tumors that prove resistant (55) . Innovative experimental approaches, like the use of monoclonal antibody–directed therapy, in which a substantially greater dose of a cytotoxic agent is delivered at the tumor site, will add to the armamentarium against chemoresistant GTT (56) .…”

Section: Discussionmentioning

confidence: 99%

Evolution of treatment of high-risk metastatic gestational trophoblastic tumors: Ain Shams University experience

El-Lamie

Sayed

Badawie

et al. 2006

Int J Gynecol Cancer

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The aim of the current study is to evaluate the different treatment modalities used in the management of high-risk metastatic gestational trophoblastic tumors (GTT) between June 1992 and December 2004 at the Gynecologic Oncology Unit, Ain Shams University. Out of 261 patients diagnosed and treated for GTT, 70 (26.8%) were high risk metastatic patients based on the National Institutes of Health clinical classification. The mean age was 29.39 +/- 9.38 years (16-55 years), with six patients (8.6%) being older than 39 years, and the mean duration of follow-up was 79.74 +/- 40.44 months (6-157 months). Forty patients (57.14%) were diagnosed after molar pregnancy, 22 (31.43%) after abortion, and 8 (11.43%) after term pregnancy. Forty-two patients (60%) were diagnosed within 4 months of the occurrence of the disease, and 28 (40%) were diagnosed after more than 4 months. Sixty-seven patients were treated using different regimens according to the protocol of treatment at that time. The MAC regimen was used initially but has been subsequently abandoned in favor of EMA-CO (etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine [Oncovin]) regimen, which was later modified by omitting the CO arm to decrease its toxicity. If resistance developed, platinum-based therapy was given in the form of EMA-EP. Recently, our unit incorporated paclitaxel in the third-line treatment. Surgical intervention was used selectively. Fifty-seven (81.4%) patients could be cured; 43 by initial chemotherapy, with a mean of 7 +/- 0.46 courses (6-15), and 14 were salvaged by second- or third-line chemotherapy. Fourteen patients (20%) died during the study period; one was unrelated to GTT, while three died of acute respiratory distress syndrome before instituting proper therapy and two died of treatment complications. Using univariate and multivariate Cox regression analyses, the presence of brain and/or liver metastases was found to be the worst prognostic variable affecting the survival, followed by resistance to combination chemotherapy and then the type of antecedent pregnancy. The projected 5-year survival as estimated by Kaplan-Meier method was 78%.

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“…Although individual cases have been reported where high-dose chemotherapy with autologous bone marrow or stem cell support has induced SCR in patients with refractory GTN, the potential role of high-dose chemotherapy is still unproven. 15,16 Therefore, in the present study, no patients were treated with high-dose chemotherapy. On the other hand, the effectiveness of salvage surgery in the selected patients with chemoresistant and relapsed GTN has been demonstrated by several authors.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of patients with relapsed and chemoresistant gestational trophoblastic neoplasia transferred to the Peking Union Medical College Hospital

Feng

Xiang

Wan

et al. 2009

BJOG

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Objective To analyse and compare the treatment outcome of the patients with gestational trophoblastic neoplasia (GTN) who were transferred to the Peking Union Medical College Hospital (PUMCH) because of chemoresistant or relapsed GTN.Design A retrospective study of the clinical features and treatment outcome of GTN after treatment failure elsewhere at the PUMCH.Setting The Department of Obstetrics and Gynecology, PUMCH, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.Population A total of 81 women with chemoresistant or relapsed GTN transferred and treated between January 2005 and December 2007.Methods A review of medical records of consecutively collected, referral cases of GTN was performed. The patients were classified according to the reasons for referral as having chemoresistant GTN if they had an incomplete response to previous treatment, and as having relapsed GTN if they had elevated serum β‐human chorionic gonadotropin (β‐hCG) levels, in the absence of a pregnancy, after the completion of initial treatment.Main outcome measures Serologic complete remission (SCR) and relapse rates.Results The patients with chemoresistant and relapsed GTN achieved 52.6 and 76.7% of the long‐term SCR rate, respectively; P = 0.035. Relapse rate and median time to relapse were similar between the chemoresistant GTN cohort and the relapsed GTN cohort after initial SCR (24 versus 35.7%, P = 0.417; 4 versus 3 months, P = 0.969).Conclusions The patients with chemoresistant GTN had a worse outcome compared with patients with relapsed GTN. The importance of obtaining a normal β‐hCG level with treatment for GTN should be emphasised, and novel therapies should be pursued for these patients.

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High-dose chemotherapy and peripheral blood stem cell support in refractory gestational trophoblastic neoplasia

Cited by 43 publications

References 9 publications

High-dose chemotherapy with autologous peripheral blood stem cell transplantation for choriocarcinoma: A case report and literature review

High-dose chemotherapy with autologous peripheral blood stem cell transplantation for choriocarcinoma: A case report and literature review

Evolution of treatment of high-risk metastatic gestational trophoblastic tumors: Ain Shams University experience

Prognosis of patients with relapsed and chemoresistant gestational trophoblastic neoplasia transferred to the Peking Union Medical College Hospital

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