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Annals of Oncology Advance Access originally published online on May 2, 2008
Annals of Oncology 2008 19(9):1578-1583; doi:10.1093/annonc/mdn181
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

gynecologic tumors

Salvage chemotherapy of relapsed or high-risk gestational trophoblastic neoplasia (GTN) with paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE)

J. Wang, D. Short, N. J. Sebire, I. Lindsay, E. S. Newlands, P. Schmid, P. M. Savage and M. J. Seckl*

Department of Health, Charing Cross Hospital Gestational Trophoblastic Disease Centre, Imperial College School of Medicine, Charing Cross Hospital, London, UK

* Correspondence to: Prof. M. J. Seckl PhD FRCP, Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. Tel: +44-208-846-1421; Fax: +44-208-748-5665; E-mail: m.seckl{at}imperial.ac.uk

Objectives: To evaluate the efficacy and toxicity of paclitaxel and cisplatin alternating with paclitaxel and etoposide doublet regimen (TP/TE), for salvage of patients with high-risk gestational trophoblastic neoplasia (GTN).

Patients and methods: Twenty-four patients with GTN received TP/TE. Sixteen had failed previous chemotherapy including six with cisplatin-based regimens (group A) and eight changed to TP/TE because of prior treatment-induced toxic effects (group B).

Results: In group A, three patients (19%) achieved a complete response (CR) and five (31%) a partial response (PR). All CR and four PR patients remain alive with a median follow-up of 25 months (range 9–48). The eight patients failing TP/TE subsequently died. Thus, the overall survival of the 16 patients in group A was 44% (seven of 16), rising to 70% (seven of 10) if the six patients who had failed prior cisplatin-based chemotherapy were excluded. In group B, four patients were assessable for response (two CR, two PR) and six remain alive (median follow-up 19 months) giving an overall survival of 75%. TP/TE was well tolerated, with only one patient discontinuing therapy because of toxic effects.

Conclusion: TP/TE is an effective, well-tolerated, salvage treatment for relapsed patients who are heavily pretreated for GTN. Further studies of this regimen are warranted.

Key words: chemotherapy, gestational trophoblastic neoplasia

Received for publication January 18, 2008. Revision received March 29, 2008. Accepted for publication March 31, 2008.


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