Journal of Clinical Oncology, Vol 15, 2636-2643, Copyright © 1997 by American Society of Clinical Oncology
EMA/CO for high-risk gestational trophoblastic tumors: results from a cohort of 272 patients [published erratum appears in J Clin Oncol 1997 Sep;15(9):3168]
M Bower, ES Newlands, L Holden, D Short, C Brock, GJ Rustin, RH Begent and KD Bagshawe
Medical Oncology Unit, Charing Cross Hospital, London, United Kingdom. m.bower@cxwms.ac.uk
PURPOSE: To evaluate the results of etoposide, methotrexate, and
dactinomycin alternating with cyclophosphamide and vincristine (EMA/CO)
chemotherapy in women with high-risk gestational trophoblastic tumors (GTT)
and to document the middle- and long-term toxicity of the regimen. PATIENTS
AND METHODS: A total of 272 consecutive women with high-risk GTT, including
121 previously treated patients, were treated with weekly EMA/CO. The
median follow-up duration is 4.5 years (range, 1 to 16). RESULTS: The
cumulative 5-year survival rate is 86.2% (95% confidence interval, 81.9% to
90.5%). No deaths from GTT have occurred later than 2 years after the end
[corrected] of EMA/CO. In a multivariate model, adverse prognostic factors
were the presence of liver metastases (P < .0001), interval from
antecedent pregnancy (P < .0001), brain metastases (P = .0008), and term
delivery of antecedent pregnancy (P = .045). There were 11 (4%) early
deaths, while 213 patients (78%) achieved a complete remission. Forty-seven
(17%) developed drug resistance to EMA/CO, of whom 33 (70%) were salvaged
by further cisplatin-based chemotherapy and surgery. Two women developed
acute myeloid leukemia, two cervical malignancy, and one gastric
adenocarcinoma after EMA/CO. More than half (56%) of the women who had
fertility-conserving surgery and who have been in remission at least 2
years have become pregnant since the completion of EMA/CO, with 112 live
births, including three infants with congenital abnormalities. CONCLUSION:
EMA/CO is an effective and well-tolerated regimen for high- risk GTT. More
than half of the women will retain their fertility; however, there is a
small but significant risk of second malignancy.
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