1168 Etoposide and actinomycin D (EA) for methotrexate (MTX) resistant, low risk, persistent gestational trophoblastic disease (GTD) and EA with MTX (MEA) for high risk GTD

Between 1986 and 1994, 174 patients were treated for persistent GTD. 146 received low dose MTX, of whom 113 were cured. 27/146 (18.5%) did not achieve normal HCG levels and received EA as salvage treatment (Etoposide 100 mg/m2 and Actinomycin D 0.5 mg daily for 3 days, 7 day interval et seq), 26/27 (96.3%) were cured with thin regimen and I required subsequent MEA (see below) before being cured. 6/146 relapsed between 2 and 40 months after complete remission. I was cured with EA, 4 with MEA and 1 requires ongoing salvage therapy. 21 patients received primary MEA (MTX 100 mg/m2 over 1 hour followed by 200 mg/m2 over 12 hours, 7 day break then EA as above, 7 day break (et seq) for high risk disease, of whom 14 (66. 7%)were cured. 3 were only cured after salvage treatment. 4 older patients with unusual histology died despite attempts at salvage. Toxicity with both EA and MEA was expected. There were no treatment related deaths or second tumours. All patients developed total alopecia. Myclotoxicity was common though not usually significant. It is concluded that EA and MEA are novel, safe and effective therapies for the treatment of MTX resistant low risk and high risk GTD respectively.