EP-EMA Regimen (Etoposide and Cisplatin With Etoposide, Methotrexate, and Dactinomycin) in a Series of 18 Women With Gestational Trophoblastic Neoplasia

Objective: Evaluation of toxicity and outcome of high-risk gestational trophoblastic neoplasia when treated with EP-EMA (etoposide, 150 mg/m(2); cisplatin, 75 mg/m(2), intravenous, day I; etoposide, 100 mg/m(2); methotrexate, 300 mg/m(2); dactinomycin, 0.5 mg, intravenous, day 8, every two weeks). Materials and Methods: We conducted a retrospective chart review of the period 2004-2010. The first-line chemotherapy regimen for high-risk gestational tropholdastic neoplasia was EP-EMA. Results: Eighteen patients were treated with EP-EMA, either as first-line chemotherapy for high-risk gestational trophoblastic neoplasia (n = 6), placental site trophoblastic tumor (n = 1), or as salvage chemotherapy for gestational trophoblastic neoplasia after single-agent methotrexate (methotrexate, 1 mg/kg, on days 1, 3, 5, and 7 every two weeks) (n = 10) or high-dose methotrexate-etoposide: methotrexate, 1000 mg/m(2), on day I; etoposide, 100 mg/m(2), on days 1 to 2, every week) (n = 1). Median number of cycles of EP-EMA was 8 (range, 3-11). Median follow-up was 19 months (range, 7-77 months). Concerning response rate, 16 patients (89%) achieved complete remission without disease recurrence. Two patients (11%) died: One patient with placental site trophoblastic tumor died of progressive disease; the second patient presented with choriocarcinoma, primarily metasta-sized to liver, lung, skin, kidney, and brain. She died of sepsis and endocarditis after adding intrathecal methotrexate and switching cisplatin to carboplatin in the EP-EMA regimen. Toxicity was significant. Eight treatment changes were made owing to grade 2 to grade 3 ototoxicity: 7 to high-dose methotrexate-etoposide, 1 change of cisplatin to carboplatin. Fifteen patients (83%) experienced grade 3/4 neutropenia