Chemotherapy for GTD

Chemotherapy uses anti-cancer drugs to kill cancer cells. The drugs attack and kill cells that divide quickly. Both cancer cells and some normal cells divide quickly. So you need to understand that chemotherapy can affect those quickly dividing normal cells as well. How chemotherapy drugs affect normal cells depend on the dose and types of drugs used. It also depends to a certain extent on you. To lower your risk of side effects, your doctor will try to give you the lowest drug dose possible.

If you have metastatic disease with "good prognosis," it’s likely you will only need to take one chemotherapy drug. If you have one or more risk factors or "poor prognosis" it’s more likely you will need a combination of chemotherapy drugs. These are usually taken at higher doses. In these situations, it is very important to try to stay on time with the chemotherapy.

If you have hydatiform moles removed but then still have persistent tumors that have not spread you have non-metastatic GTD. In that case, you will receive methotrexate or actinomycin-D. The methotrexate is given once a week. The usual way it’s given is as an intramuscular injection. There are, though, other ways it can be given. The actinomycin-D treatment is usually a quick intravenous treatment. It’s normally given every 2 weeks. But other dosing schedules may are possible. The treatments are given until the beta hCG disappears completely or returns to normal. It’s possible that after your HCG level returns to the normal, you will still get at least two more courses or cycles of treatment.

Side effects of the methotrexate and actinomycin-D are different. So the choice of these drugs may be guided by the following:

  • other diseases, such as liver or kidney disease
  • your schedule
  • your acceptance of side effects

A recent GOG study has shown a benefit to using actinomycin-D in some patients with mild but different side effects.

This treatment is also useful if you have good prognosis metastatic GTD. If the response in not complete and the beta hCG persists or rises, then the other single agent chemotherapy will be considered. About 10% to 15% of the time a combination treatment called EMA-CO is used. This is a combination of etoposide, methotrexate, actinomycin-D, cyclophosphamide and Oncovin. All treatments are continued for at least 2 cycles after the hCG has come back to normal.

With poor prognosis GTD combination chemotherapy is often used. It may also be used if you have any of the risk factors used in the poor prognosis scoring system:

  • last pregnancy was over 4 months ago
  • high level of HCG in the blood
  • cancer has spread or metastasized to the liver or brain
  • cancer was not successfully treated by chemotherapy
  • tumor grew after a normal pregnancy and birth

Several combination chemotherapy regimens exist. The most common combination used is EMA-CO. It is very important that these drugs are given on schedule. It is also very important to work with the oncology team during your treatments.

Below is a list of chemotherapy questions you can ask your doctor. They can help you get the information you should have about your treatment.

Chemotherapy Questions

  • Why do I need this treatment?
  • What drugs will I be taking? How often? For how long? What will they do?
  • What can I do about side effects?
  • How long will I be on this treatment?