Chemotherapy drugs for persistent trophoblastic disease and choriocarcinoma

Persistent trophoblastic disease and choriocarcinoma are types of gestational trophoblastic tumours (GTTs). This link takes you to general information about GTTs.

The treatment you have depends on the stage of your disease and the risk of your disease coming back. Also, the chemotherapy drugs you have may be slightly different depending on the specialist centre where you are being treated. 

If you have a low risk of the chemotherapy not getting rid of the GTT completely, you will have low risk chemotherapy. Low risk treatment is usually a drug called methotrexate given into a muscle. If you have a higher risk of the chemotherapy not getting rid of the GTT completely, or if the GTT comes back after methotrexate treatment, you will have high risk treatment. High risk treatment is 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 is no GTT 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.

If your GTT is at low risk of coming back 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 (known as methotrexate resistance), you will change chemotherapy and have dactinomycin. You may have this in combination with etoposide. You have both of these drugs through a drip into your vein.

If you have dactinomycin on its own, you have this every day for 5 days, every 2 weeks. If you have dactinomycin and etoposide, you have these every day for 3 days. Each of these drugs takes about an hour. You have a week off before starting the cycle again.

If your hCG levels are above 300 IU/L (international units per litre), you may have a combination of chemotherapy drugs called EMA-CO instead. This combination is also used for women who have high risk treatment.

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

Or you may have a combination of chemotherapy drugs called EMA-CO. You have the drugs etoposide, methotrexate and dactinomycin (actinomycin-D) 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 does not get rid of GTT completely, you may have treatment with etoposide, methotrexate and dactinomycin, followed a week later by etoposide and cisplatin (EMA-EP chemotherapy). 

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.

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 react more 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 tends not to cause too many side effects. But you may have

• Changes in your sense of taste
• Mouth sores and ulcers
• Diarrhoea
• Gritty eyes
• Pain in your chest

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

• Increased risk of infections
• Fatigue (tiredness)
• Feeling and being sick

Etoposide, dactinomycin, 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.

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 them 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 of CancerHelp UK.

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.

The main chemotherapy section in CancerHelp UK has general information about chemotherapy, including

• What chemotherapy treatment involves
• How your doctor plans your chemotherapy
• How you have treatment
• General side effects
• Living with chemotherapy

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