Experience with platinum-based and high-dose chemotherapy in patients with gestational trophoblastic disease: possible implications for future management

Purpose. Despite the similarities between the chemotherapeutic management of advanced gestational trophoblastic disease (GTD) and ovarian germ cell tumors, important differences exist between the malignancies, particularly in the use of cisplatin. Methods. Three patients with persistent or recurrent GTD cared for at the Cleveland Clinic received a high-dose chemotherapy program (with stem cell support), one as management for etoposide-associated acute leukemia resulting from her "standard dose" treatment program. Results. While the indications for use of a dose-intensive strategy, and the ultimate clinical course, differed in the three patients, collectively these cases raise relevant questions regarding optimal management of high risk and recurrent GTD. Conclusion. The experience represented in this report support the earlier use of cisplatin-based chemotherapy in the management of high-risk and recurrent GTD, and the possible administration of a high-dose chemotherapy program in the rare patient who recurs following "standard dose" platinum-based treatment.