Chemotherapy treatment

Chemotherapy can be used to treat persistent trophoblastic disease (PTD) and choriocarcinoma.

PTD is a tumour that can form in the womb after an abnormal type of pregnancy called a molar pregnancy. Choriocarcinoma is a very rare tumour that can occur after a normal pregnancy, a molar pregnancy, a miscarriage or a termination of pregnancy (abortion).

About chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy tumour cells. They work by disrupting their growth. Chemotherapy circulates in the bloodstream around the body.

Your doctors will look at various factors to find the stage of your disease. This helps them to decide which chemotherapy treatment you need – low or high risk treatment. 

Low risk chemotherapy for persistent trophoblastic disease

You have treatment with methotrexate as low risk chemotherapy if you have PTD after a molar pregnancy.

You have the methotrexate 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 might 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 30 hours after each injection. This helps to reduce the side effects of the methotrexate.

For many women, the methotrexate gets rid of the PTD completely and they need no further treatment.

If the hCG levels don't go down

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 hCG is below a certain level you will have actinomycin on its own. You have it through a drip into a vein. You have it once every 2 weeks. 

If your hCG is above a certain level you will 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 chemotherapy for persistent trophoblastic disease or choriocarcinoma

If you have high risk PTD or choriocarcinoma, you might 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 your PTD or choriocarcinoma 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).

Depending on the combinations of drugs you have, you might have some treatment as an in patient.  You continue having treatment until your hCG levels go back to normal and for 6 more weeks after that.

Into your bloodstream

If you have treatment into your bloodstream you have it through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Where you have chemotherapy

You have chemotherapy treatment at one of the specialist GTD centres in the UK (Charing Cross hospital in London or Weston Park hospital in Sheffield).

You might be able to have some of your outpatient treatment at your local hospital, if they have a chemotherapy service. If you are having methotrexate as an injection, your GP might be able to do this. The team at your specialist centre will tell you if either of these would be possible for you.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these the day before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Side effects

Common chemotherapy side effects include:

• feeling sick
• loss of appetite
• losing weight
• feeling very tired
• increased risk of getting an infection
• bleeding and bruising easily
• diarrhoea or constipation
• hair loss

Side effects depend on:

• which drugs you have
• how much of each drug you have
• how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

When you go home

Chemotherapy for persistent trophoblastic disease and choriocarcinoma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.