Combination chemotherapy for primary treatment of high-risk gestational trophoblastic tumour

The combination of methotrexate, actinomycin D and chlorambucil (MAC)might possibly be as effective with less toxicity as the combination of cyclophosphamide, hydroxyurea, actinomycin D, methotrexate, doxorubicin, melphalan and vincristine (CHAMOCA) for high-risk gestational trophoblastic disease, although the data are insufficient.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding).

Summary

A Cochrane review included 1 study with a total of 42 subjects. Women with high-risk gestational trophoblastic neoplasia were randomised to MAC (methotrexate, actinomycin D and chlorambucil) or the modified CHAMOCA regimen (cyclophosphamide, hydroxyurea, actinomycin D, methotrexate, doxorubicin, melphalan and vincristine). There were no statistically significant differences in efficacy of the two regimens; however women in the MAC group experienced statistically significantly less toxicity overall and less haematological toxicity than women in the CHAMOCA group. During the study period, six women in the CHAMOCA group died compared with one in the MAC group, thus the study was stopped early due to unacceptable levels of toxicity in the CHAMOCA group. There were no RCTs comparing EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) with MAC or other chemotherapy regimens.

Clinical comments

Date of latest search: 14 November 2012

Ədəbiyyat

1. Deng L, Yan X, Zhang J et al. Combination chemotherapy for high-risk gestational trophoblastic tumour. Cochrane Database Syst Rev 2009;(2):CD005196 (Last assessed as up-to-date: 14 November 2012).