Gestational Trophoblastic Neoplasia Medication

  • Author: Enrique Hernandez, MD, FACOG, FACS; Chief Editor: Warner K Huh, MD   more...
 
Updated: Jan 30, 2012
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to eradicate the neoplasm.

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Antineoplastics

Class Summary

Gestational trophoblastic tumors are sensitive to many antineoplastic agents, especially those that act in the S phase or the M phase of the cell cycle.

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Methotrexate (Folex PFS, Rheumatrex)

 

Used both as single agent and in multiagent regimens for the treatment of malignant GTN.

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Actinomycin D (Dactinomycin)

 

Intercalates between guanine and cytosine base pairs, inhibiting DNA and RNA synthesis and protein synthesis. Use as single agent or as part of multiagent regimen for treatment of malignant GTN.

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Cyclophosphamide (Cytoxan, Neosar)

 

Chemically related to nitrogen mustards. As alkylating agent, mechanism of action of active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells. Part of multiagent chemotherapy regimens used to treat high-risk metastatic GTN.

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Etoposide (Toposar, VePesid)

 

Inhibits topoisomerase II and causes DNA strand breakage, causing cell proliferation to arrest in late S or early G2 portion of cell cycle. One of the drugs in multiagent chemotherapy regimens used to treat patients with high-risk metastatic GTN.

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Vincristine (Oncovin, Vincasar PFS)

 

Blocks mitosis; one of the drugs included in multiagent chemotherapy regimens used to treat patients with high-risk metastatic GTN.

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Cisplatin (Platinol)

 

Inhibits DNA synthesis and, thus, cell proliferation, by causing DNA cross-links and denaturation of double helix. Effective antineoplastic used in patients with chemotherapy-resistant malignant GTN.

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Chemotherapy modulating agent

Class Summary

May be used to alleviate toxic adverse effects of MTX. MTX blocks conversion of uridine to thymidine, one of the building blocks of DNA. Folinic acid provides a methyl group to uridine monophosphate, thus forming thymidine monophosphate, overcoming effects of MTX on tetrahydrofolic acid reductase.

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Leucovorin (Wellcovorin)

 

Used to prevent toxicity from high doses of MTX.

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Contributor Information and Disclosures
Author

Enrique Hernandez, MD, FACOG, FACS  Chairman, Department of Obstetrics and Gynecology, Director of Gynecologic Oncology, Abraham Roth Professor of Obstetrics, Gynecology and Reproductive Science, Professor of Pathology, Temple University Hospital, Temple University School of Medicine

Enrique Hernandez, MD, FACOG, FACS is a member of the following medical societies: Alpha Omega Alpha, American Cancer Society, American College of Obstetricians and Gynecologists, American College of Surgeons, American Gynecological and Obstetrical Society, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Johns Hopkins Medical and Surgical Association, Pennsylvania Medical Society, Philadelphia County Medical Society, and Society of Gynecologist Oncologists

Disclosure: GSK Honoraria Speaking and teaching

Specialty Editor Board

Robert C Shepard, MD, FACP  Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Warner K Huh, MD  Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Senior Scientist, Comprehensive Cancer Center, University of Alabama School of Medicine

Warner K Huh, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, American Society of Clinical Oncology, Massachusetts Medical Society, and Society of Gynecologist Oncologists

Disclosure: MERCK Consulting fee Consulting; ROCHE PHARMA/DIAGNOSTICS Consulting fee Consulting; INTUITIVE SURGICAL Proctor Fee Consulting; Qiagen Consulting fee Consulting

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Histologic section of a complete hydatidiform mole stained with hematoxylin and eosin. Villi of different sizes are present. The large villous in the center exhibits marked edema with a fluid-filled central cavity known as cisterna. Marked proliferation of the trophoblasts is observed. The syncytiotrophoblasts stain purple, while the cytotrophoblasts have a clear cytoplasm and bizarre nuclei. No fetal blood vessels are in the mesenchyme of the villi.
In this microphotograph of a choriocarcinoma metastatic to the brain, the neuropil is seen on the right and the biphasic (2 cell populations) choriocarcinoma is seen to the left with hemorrhage at the left border of the photograph (H&E stain).
Table. Prognostic Scoring Index
Prognostic FactorPoints
Age ≥40 y1
Antecedent pregnancy terminated in abortion1
Antecedent full-term pregnancy2
Interval of 4-7 mo between antecedent pregnancy and start of chemotherapy1
Interval of 7-12 mo between antecedent pregnancy and start of chemotherapy2
Interval of more than 12 mo between antecedent pregnancy and start of chemotherapy4
Beta-hCG level in serum is 1,000 to < 10,000 mIU/mL1
Beta-hCG level in serum is 10,000 to < 100,000 mIU/mL2
Beta-hCG level in serum is ³100,000 mIU/mL4
Largest tumor is 3 cm to < 5 cm1
Largest tumor is ³5 cm2
Site of metastases is spleen or kidney1
Site of metastases is gastrointestinal tract2
Site of metastases is brain or liver4
Number of metastases is 1-41
Number of metastases is 5-82
Number of metastases is >84
Prior chemotherapy with single drug2
Prior chemotherapy with multiple drugs4
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