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Chemotherapy drugs for persistent trophoblastic disease and choriocarcinoma

Men and women discussing gestational trophoblastic tumours

This page tells you about the chemotherapy drugs used to treat persistent trophoblastic disease (PTD) and choriocarcinoma. There is information about

 

A quick guide to what's on this page

Chemotherapy drugs for persistent trophoblastic disease and choriocarcinoma

Persistent trophoblastic disease (PTD) and choriocarcinomas are types of pregnancy related tumours called gestational trophoblastic tumours (GTTs).

Depending on whether the tumour has spread (the stage of your disease), you’ll have either one chemotherapy drug or a combination of drugs. The number of courses of chemotherapy you need to have will depend on the levels of a hormone in your blood called hCG.

PTDs are divided into low risk and high risk disease. If your tumour is low risk you will have treatment with a drug called methotrexate. You have this as an injection into a muscle. You also have a tablet called folinic acid 24 hours after each injection. The folinic acid helps to reduce the side effects of methotrexate. If your hCG levels don’t go back to normal, you will change chemotherapy and have drugs through a drip into a vein.

PTDs and choriocarcinomas in the high risk group have a combination of chemotherapy drugs through a drip into a vein. You may have slightly different treatment depending on which hospital is treating you. The drugs used may include methotrexate, actinomycin, etoposide, cyclophosphamide, and vincristine.

Possible side effects of the drugs

The side effects you get depend on the drugs and dose that you have, and how you individually react to them. Possible side effects include increased risk of infections, tiredness (fatigue), feeling and being sick, taste changes, mouth sores and ulcers, diarrhoea, gritty eyes, pain in your chest and hair thinning or hair loss.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating persistent trophoblastic disease and choriocarcinoma section.

 

 

About chemotherapy for PTD and choriocarcinoma

Persistent trophoblastic disease (PTD) and choriocarcinoma are types of pregnancy related tumours called gestational trophoblastic tumours (GTTs).

The treatment you have depends on whether the tumour has spread (the stage of your disease). PTD tumours are divided into low risk and high risk groups. Choriocarcinomas and some PTDs are in the high risk group. Chemotherapy can cure most women with low risk or high risk tumours. The chemotherapy drugs you have may be slightly different depending on the specialist centre treating you. 

If you have low risk chemotherapy the treatment is usually a drug called methotrexate given into a muscle. 

If you have high risk treatment or if the GTT comes back after methotrexate treatment, you will have a combination of chemotherapy drugs given into a vein.

The number of courses of chemotherapy you need will depend on your hCG blood levels. During your treatment your doctor will take regular blood tests to measure these levels. Your chemotherapy will continue until there are no signs of the hCG hormone in your blood. When this happens it means that there are no tumour cells left in your body. You then have chemotherapy for 6 more weeks after that. As a guide, most women need treatment for between 3 to 6 months.

 

Low risk treatment

If your GTT is in the low risk group you will have treatment with methotrexate. You have this as an injection into a muscle (intramuscularly) every other day. This is usually into one of the large muscles in your leg or your bottom (buttock). You may have to stay in hospital for your first week of treatment. But you can usually have the rest of your treatment as an outpatient.

You have 4 injections in total, then 7 days with no treatment before the next cycle begins. You will also take a tablet of folinic acid about 24 hours after each injection. This helps to reduce the side effects of the methotrexate. For many women, the methotrexate gets rid of the GTT completely and they need no further treatment.

If your hCG levels don't go back down to normal or they begin to go up again, it is known as methotrexate resistance. You will change chemotherapy.

If your level of hCG is below 300 IU/L you will have actinomycin on its own. You have it through a drip into a vein. You may have it either

  • Every day for 5 days, every 2 weeks or
  • Once every 2 weeks

If your hCG level is above 300 IU/L you will have have one of the following treatments

  • EMA-CO – etoposide, methotrexate, actinomycin one week, followed by cyclophosphamide and vincristine (oncovin) a week later
  • Actinomycin and etoposide every day for 3 days, with a 1 week break before starting a new treatment cycle
  • Carboplatin

You have these drugs through a drip into your vein.

 

High risk treatment

If you have high risk PTD or choriocarcinoma, you may have the drug methotrexate by drip into a vein (intravenous infusion). This is followed a week later by the drugs actinomycin and etoposide

Or you may have a combination of chemotherapy drugs called EMA-CO. You have the drugs etoposide, methotrexate and actinomycin by drip over 2 days. The following week you have the drugs cyclophosphamide and vincristine (oncovin). You then start the cycle again.

If this chemotherapy doesn't get rid of GTT completely, you may have treatment with etoposide, methotrexate and actinomycin, followed a week later by etoposide and cisplatin (EMA-EP chemotherapy). Or you may have the drugs paclitaxel (Taxol) and cisplatin followed 2 weeks later by paclitaxel (Taxol) and etoposide (TP-TE).

You will need to be in hospital while you are having chemotherapy but you may be able to go home between cycles. You will continue having treatment until your hCG levels go back to normal and for 6 more weeks after that.

 

Possible side effects of the drugs

Chemotherapy drugs all have different side effects. The side effects depend on

  • The drugs you have
  • The dose of the drugs
  • How you react as an individual

People vary in how chemotherapy affects them. Some people have more side effects than others. And different drugs have different side effects. So we can't tell you exactly what might happen to you. Most side effects only last for the few days that you are actually having the drugs. And you can have medicines to help.

Methotrexate into a muscle usually only causes mild side effects. But you may have

Some common side effects of all the drugs given into a vein for GTT include

Etoposide, actinomycin, cyclophosphamide and vincristine can all cause hair thinning or hair loss.

You can click on the drug names above to get a full list of the specific side effects for each drug.

 

Dietary or herbal supplements and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed therapies by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking, these supplements talk to your doctor to find out whether they could affect your treatment.

 

More about chemotherapy

The main chemotherapy section has general information about chemotherapy, including

If you would like more information about anything to do with chemotherapy, contact our cancer information nurses. They would be happy to help.

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Updated: 6 May 2014