Oral etoposide for metastatic choriocarcinoma: a case report and review of guidelines
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Background and purpose
Choriocarcinoma (CCA) is a rare form of malignant trophoblastic disease. Systemic polychemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA/CO) is the mainstay of treatment for metastatic disease. Due to the rarity of the condition, however, the evidence basis for this management is small and other chemotherapy regimens may also be effective. The reported case presents anecdotal evidence of an effective etoposide monotherapy treatment.
Method: case presentation
We report the case of a patient with gestational choriocarcinoma and pulmonary metastases initially treated with methotrexate. Due to local disease progression, she underwent hysterectomy and continued treatment with methotrexate. After pulmonary progression, she was switched to oral etoposide.
After four cycles of etoposide monotherapy at a oral dosage of 100 mg d1–7, q28, the patient had no evidence of disease according to human chorionic gonadotropin serum levels and imaging studies. The treatment was well tolerated with World Health Organization (WHO) grade 2 alopecia and hot flushes as the most prominent side effects. The patient has achieved a sustained complete remission with a follow-up of 6 years.
Oral etoposide may be an effective treatment alternative to EMA/CO in selected patients with oligometastatic CCA.
KeywordsChoriocarcinoma Etoposide Chemotherapy Angioinvasion Metastasis
GPB: protocol/project development, data collection and management, data analysis, manuscript writing. PS: data collection and management. CV: images collection and management, histopathological data analysis. SDC: project development, data analysis. WK: manuscript review, editing. EFS: manuscript review, editing. IJ-B: data analysis, manuscript writing, editing. CT: data analysis, manuscript writing, editing.
This study was not funded.
Compliance with ethical standards
Conflict of interest
All of the authors (Georg-Peter Breitbach, Panagiotis Sklavounos, Christian Veith, Serban-Dan Costa, Walther Kuhn, Erich-Franz Solomayer, Ingolf Juhasz-Boess, Clemens Tempfer) declare that they have no conflict of interest.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent for publication of this case report was received and personally signed from the patient on 2017-09-07.
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