Chemotherapy regimens used in the treatment of gestational trophoblastic Philippine general hospital - Treatment outcomes and toxicity

OBJECTIVE: To describe different chemotherapy regimens used in the treatment of gestational trophoblastic neoplasia (GTN). METHODS: A retrospective study of GTN cases from January 1999 to December 2004 at Philippine General Hospital was done. Patients with nonmetastatic and metastatic low-risk disease were managed by single-agent chemotherapy. Those with high-risk disease were given multiple-agent chemotherapy. RESULTS: Forty-five percent of patients (87/193) manifested adverse reactions to chemotherapy. Adverse effects include anemia in 51.7% (45/87), leukopenia in 16% (14/87), neutropenia in 72.4% (63/87) and elevated liver enzymes in 21.8% (19/87). Symptoms included vomiting in 9.1% (8/87) of cases, diarrhea in 6.8% (6/87), stomatitis in 24.14% (21/87) and febrile neutropenia in 19.5% (17/87). There was a significant difference between the 3 groups of regimens in terms of anemia (p = 0.002), leukopenia (p = 0.011), neutropenia (p < 0.001) and stomatitis (p < 0.001). Patients treated with etoposide, methotrexate, actinomycin (ACT), cyclophosphamide and vineristine and with etoposide, methotrexate, ACT, taxanes and cisplatin experienced most of the toxicity. CONCLUSION: In the Philippine General Hospital, methotrexate is first-line. single-agent chemotherapy for low-risk GTN. Etoposide, methotrexate, ACT, cyelophosphamide and vincristine regimen are the first line for high-risk metastatic GTN. Present regimens are effective but predispose patients to a variety of toxicities. Patients' acceptance and tolerance of adverse effects and ability to secure drug resources are factors contributing to the success of the treatment.