Current Clinical Trials

Recurrent disease indicates failure of prior chemotherapy unless initial therapy was surgery alone. A study found recurrence of disease in 2.5% of patients with nonmetastatic disease, 3.7% of patients with good-prognosis metastatic disease, and 13% of patients with poor-prognosis metastatic disease.[1] All recurrences were within 36 months of remission (85% before 18 months). Prior chemotherapy failure automatically places the patient into the high-risk (poor prognosis) category. These patients should be treated with aggressive chemotherapy. For resistant high-risk gestational trophoblastic tumors (GTTs), combinations of etoposide, cisplatin, and either dactinomycin or bleomycin have shown promising results.[2,3] A patient who has failed primary surgical therapy is generally treated with single-agent chemotherapy unless one of the poor-prognosis factors that requires combination chemotherapy supervenes.

A select group of patients with chemotherapy-resistant and clinically detectable GTT may benefit from salvage surgery.[4]

When central nervous system metastases are identified, whole brain radiation therapy (30 Gy in 2 Gy fractions) is given simultaneously with the initiation of systemic chemotherapy. Approximately 50% to 60% of patients will achieve sustained remission using this treatment approach. The outcome for women presenting with hepatic metastases from GTT disease is poor with an even worse prognosis if cerebral metastases are also present.[5,6] Chemotherapy with ifosfamide, carboplatin, and etoposide may be considered for patients with recurrent GTTs metastatic to the brain.[7]

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent gestational trophoblastic tumor ¹. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site ².

References

1. Mutch DG, Soper JT, Babcock CJ, et al.: Recurrent gestational trophoblastic disease. Experience of the Southeastern Regional Trophoblastic Disease Center. Cancer 66 (5): 978-82, 1990.  [PUBMED Abstract]
   
   
2. Theodore C, Azab M, Droz JP, et al.: Treatment of high-risk gestational trophoblastic disease with chemotherapy combinations containing cisplatin and etoposide. Cancer 64 (9): 1824-8, 1989.  [PUBMED Abstract]
   
   
3. Surwit EA: Management of high-risk gestational trophoblastic disease. J Reprod Med 32 (9): 657-62, 1987.  [PUBMED Abstract]
   
   
4. Lehman E, Gershenson DM, Burke TW, et al.: Salvage surgery for chemorefractory gestational trophoblastic disease. J Clin Oncol 12 (12): 2737-42, 1994.  [PUBMED Abstract]
   
   
5. Small W Jr, Lurain JR, Shetty RM, et al.: Gestational trophoblastic disease metastatic to the brain. Radiology 200 (1): 277-80, 1996.  [PUBMED Abstract]
   
   
6. Crawford RA, Newlands E, Rustin GJ, et al.: Gestational trophoblastic disease with liver metastases: the Charing Cross experience. Br J Obstet Gynaecol 104 (1): 105-9, 1997.  [PUBMED Abstract]
   
   
7. Piamsomboon S, Kudelka AP, Termrungruanglert W, et al.: Remission of refractory gestational trophoblastic disease in the brain with ifosfamide, carboplatin, and etoposide (ICE): first report and review of literature. Eur J Gynaecol Oncol 18 (6): 453-6, 1997.  [PUBMED Abstract]