Recurrent Gestational Trophoblastic Tumors
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]
Current Clinical Trials
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
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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.
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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]
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Surwit EA: Management of high-risk gestational trophoblastic disease. J Reprod Med 32 (9): 657-62, 1987.
[PUBMED Abstract]
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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]
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Small W Jr, Lurain JR, Shetty RM, et al.: Gestational trophoblastic disease metastatic to the brain. Radiology 200 (1): 277-80, 1996.
[PUBMED Abstract]
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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]
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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]
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