High-risk metastatic gestational trophoblastic neoplasia. Primary management with EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) chemotherapy.

OBJECTIVE: To describe and evaluate the clinical profile and response of patients with metastatic high-risk gestational trophoblastic neoplasia (GTN) to EMA-CO and other adjuvant treatment.

STUDY DESIGN: A retrospective, descriptive analysis of data was done using charts of diagnosed cases of GTN from 2006-2010. The patients were classified according to the International Federation of Gynecology and Obstetrics anatomic staging and World Health Organization prognostic scoring. Clinical profiles of patients and response to EMA-CO chemotherapy and other surgical procedures in terms of remission rates, toxicities and mortality were evaluated.

RESULTS: Seventy-three patients had metastatic high-risk disease. Sixty-seven patients were started on EMA-CO as first-line treatment. Only 56 completed treatment. Of those 56 patients, 30% underwent adjuvant surgical therapy. Primary remission rate with EMA-CO was 72%. Sustained remission rate after chemotherapy and other adjuvant procedures was 80%. Overall survival rate was 86% at the time of this writing. Of the 8 patients who died, 5 had stage IV disease while 3 had stage III disease. Factors that significantly affected response to EMA-CO were pretreatment hCG levels >100,000 mIU/mL and stage IV disease. The most common toxicities associated with the regimen were hematologic in nature.

CONCLUSION: The use of EMA-CO chemotherapy as primary treatment for patients with metastatic high-risk GTN resulted in a primary remission rate of 72% and sustained remission rate of 80%. A survival rate of 86% was seen in this study.