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Salvage combination chemotherapy with 5-fluorouracil and actinomycin D
for patients with refractory, high-risk gestational trophoblastic tumors
Actinomycin D:
Salvage combination chemotherapy with 5-fluorouracil and actinomycin D for
patients with refractory, high-risk gestational trophoblastic tumors.
Cancer 2002 Sep 1;95(5):1051-4
Salvage combination chemotherapy with 5-fluorouracil and
actinomycin D for patients with refractory, high-risk gestational
trophoblastic tumors.
Matsui H, Suzuka K, Iitsuka Y, Yamazawa K, Tanaka N, Mitsuhashi A, Seki K,
Sekiya S.
Department of Obstetrics and Gynecology, Chiba University School of Medicine,
Chiba, Japan. hmatsui@med.m.chiba.u.ac.jp
BACKGROUND: The objective of this study was to evaluate the efficacy and
toxicity of a high-dose 5-fluorouracil and actinomycin D regimen (the FA
regimen) as salvage chemotherapy for patients with high-risk gestational
trophoblastic tumors (GTTs). METHODS: From 1985 to 1997, 10 patients with
refractory, high-risk GTTs were treated with the FA regimen at Chiba
University Hospital. Of those 10 patients, 7 patients developed drug
resistance to methotrexate, etoposide, and actinomycin D combination
chemotherapy (the MEA regimen); 1 patient developed recurrent disease after
receiving the MEA regimen; and 2 patients developed recurrent disease after
receiving combination chemotherapy with etoposide, methotrexate, and
actinomycin D alternating with cyclophosphamide and vincristine (the EMA/CO
regimen). The hematologic toxicity of the FA regimen was graded at every
chemotherapy course. RESULTS: With the FA regimen, the survival rate was 80.0%
(8 of 10 patients) for a mean follow-up of 10 years. Two patients died due to
multidrug resistance, and two patients subsequently developed recurrent
disease. The two patients with recurrent disease were successfully salvaged
again with the MEA regimen. The toxicity of the FA regimen was evaluated in 78
cycles. Myelosuppression seemed to be the dose-limiting toxicity, and the
incidences of World Health Organization Grade 4 leukocytopenia and
thrombocytopenia were 6.4% and 3.8%, respectively, of 78 cycles. CONCLUSIONS:
Although etoposide-containing chemotherapy is currently the most effective and
well-tolerated regimen for patients with high-risk GTTs, 20-30% of patients
develop resistance to etoposide-containing regimens. Salvage combination
chemotherapy with FA is effective for these patients with refractory disease,
and the toxicity is predictable and manageable. Copyright 2002 American Cancer
Society.
