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The Role of Methotrexate in the Chemotherapy of Gestational Trophoblastic Neoplasms

  • Alberto Sobrero
  • Joseph R. Bertino
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 176)

Abstract

The successful use of methotrexate in metastatic choriocarcinoma in 1956 (1) marked a milestone in the history of curative cancer chemotherapy. The survival of patients with widespread disease increased from 10% in the pre-chemotherapy era (2) to 47% in 1961 (3), 74% in 1965 (4), and to about 90% at the present time (5–7). These improvements in survival resulted from improved chemotherapeutic regimens for a disease which presents certain unique features. Methotrexate has played a central role in these regimens, most of the time being the only drug used. The work of centers for the study and treatment of gestational trophoblastic neoplasms, established in the mid-1960s, has also contributed to the more rational use of this drug as new knowledge of clinical pharmacology was developed (8). In this paper, drug treatment for gestational trophoblastic neoplasms is reviewed, with emphasis on the use of methotrexate.

Keywords

Central Nervous System Metastasis Single Agent Chemotherapy Gestational Trophoblastic Disease Molar Pregnancy Gestational Trophoblastic Neoplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Li, M. C., Hertz, R., and Spencer, D. B., Effect of methotrexate therapy upon choriocarcinoma and chorioadenoma, Proc. Soc. Exptl. Biol. Med. 93:361 (1956).Google Scholar
  2. 2.
    Brewer, J. I., Smith, R. T., and Pratt, G. B., Choriocarcinoma, absolute 5 year survival rates of 122 patients treated by hysterectomy, Amer. J. Obstet. Gynecol. 85:841 (1963).Google Scholar
  3. 3.
    Hertz, R., Lewis, J., Jr., and Lipsett, M. B., Five years experience with the chemotherapy of metastatic choriocarcinoma and related trophoblastic tumors in women, Amer. J. Obstet. Gynecol. 82:631 (1961).Google Scholar
  4. 4.
    Ross, G. T., Goldstein, D. P., Hertz, R., Lipsett, M. B., and Odell, W. D., Sequential use of methotrexate and actinomycin D in the treatment of metastatic choriocarcinoma and related trophoblastic diseases in women, Amer. J. Obstet. Gynecol. 93: 223 (1965).Google Scholar
  5. 5.
    Lewis, J. L., Jr., Treatment of metastatic gestational trophoblastic neoplasms, Amer. J. Obstet. Gynecol. 136:163 (1980).Google Scholar
  6. 6.
    Newlands, E. S. and Bagshawe, K. D., International symposium on gestational trophoblastic tumours, Brit. J. Cancer 41:144 (1980).CrossRefGoogle Scholar
  7. 7.
    Lurain, J. R., Brewer, J. I., Torok, E. E., and Halpern, B., Gestational trophoblastic disease: treatment results at the Brewer Trophoblastic Disease Center, Obstet. Gynecol. 60:354 (1982).PubMedGoogle Scholar
  8. 8.
    Brewer, J. I., Eckman, T. R., Dolkart, R. E., Torok, E. E., and Webster, A., Gestational trophoblastic disease. A comparative study of the results of therapy in patients with invasive mole and with choriocarcinoma, Amer.J. Obstet. Gynecol.109: 335 (1971). Google Scholar
  9. 9.
    Hreshchyshyn, M. M., Trophoblastic neoplasia, in: “Cancer Medicine,” J. F. Holland and E. Frei, eds., Lea and Febiger, Philadelphia (1981).Google Scholar
  10. 10.
    Bagshawe, K. D., Risk and prognostic factors in trophoblastic neoplasia, Cancer 38:1373 (1976).PubMedCrossRefGoogle Scholar
  11. 11.
    Jones, W. B., Gestational trophoblastic disease: Is human chorionic gonadotropin the ideal tumor marker: in: “Gynecologic Oncology,” S. C. Ballon, ed., G. K. Hall, Boston (1982).Google Scholar
  12. 12.
    Lewis, J. L., Jr., Chemotherapy of gestational choriocarcinoma, Cancer 30:1517 (1972).PubMedCrossRefGoogle Scholar
  13. 13.
    Goldstein, D. P. and Berkowitz, R. S., Management of gestational trophoblastic neoplasms, Curr. Probl. Obstet. Gynecol. 3:1 (1980).Google Scholar
  14. 14.
    Pattillo, R. A., Immunology of gestational trophoblastic neoplasms, Semin. Oncol. 9:157 (1982).PubMedGoogle Scholar
  15. 15.
    Nelson, M. M., and Evans, H. M., Pteroylglutamic acid and reproduction in the rat, J. Nutr. 38:11 (1948).Google Scholar
  16. 16.
    Hertz, R. and Tullner, W. W., Quantitative interference with estrogen-induced tissue growth by folic acid antagonists, Endocrinology 44:278 (1949).PubMedCrossRefGoogle Scholar
  17. 17.
    Hertz, R., Interference with estrogen-induced tissue growth in the chick genital tract by a folic acid antagonist, Science 107:300 (1948).PubMedCrossRefGoogle Scholar
  18. 18.
    Thiersh, J. B. and Phillips, F. S., Effect of 4-amino pteroylglutamic acid (aminopterin) on early pregnancy, Proc. Soc. Exptl. Biol. Med. 74:204 (1950).Google Scholar
  19. 19.
    Thiersh, J. B. and Phillips, F. S., Therapeutic abortion with a folic acid antagonist, 4-amino pteroylglutamic acid administered by oral route, Amer. J. Obstet. Gynecol. 63: 1298 (1952).Google Scholar
  20. 20.
    Li, M. C., Hertz, R., and Bergenstal, D. M., Therapy of choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists, New En&l. J. Med. 239:66 (1958).Google Scholar
  21. 21.
    Hertz, R., Bergenstal, D. M., Lipsett, M. B., Parke, E. B., and Hilbish, T. F., Chemotherapy of choriocarcinoma and related tumors in women, J. Amer. Med. Assoc. 168:845 (1958).CrossRefGoogle Scholar
  22. 22.
    Hertz, R., Ross, G. T., and Lipsett, M. B., Primary chemotherapy of nonmetastatic trophoblastic disease in women, Amer. J. Obstet. Gynecol. 86:808 (1963).Google Scholar
  23. 23.
    Li, M. C., Management of choriocarcinoma and related tumors of uterus and testis, Med. Clin. North Amer. 45:661 (1961).Google Scholar
  24. 24.
    Ross, G. T., Stolbach, L. L., and Hertz, R., Actinomycin D in the treatment of methotrexate-resistant trophoblastic disease in women, Cancer Res. 22:1015 (1962).PubMedGoogle Scholar
  25. 25.
    Osathanondth, R., Goldstein, D. P., and Pastorfide, G. B., Actinomycin D as the primary agent for gestational trophoblastic disease, Cancer 36:863 (1975).CrossRefGoogle Scholar
  26. 26.
    Bagshawe, K. D. and McDonald, J. M., Treatment of choriocarcinoma with a combination of cytotoxic drugs, Brit. Med. J. 426 (1960).Google Scholar
  27. 27.
    Hammond, C. B. and Parker, R. T., Diagnosis and treatment of trophoblastic disease, Obstet. Gynecol. 35:132 (1970).Google Scholar
  28. 28.
    Goldstein, D. P., The chemotherapy of gestational trophoblastic disease, J. Amer. Med. Assoc. 220:209 (1972).CrossRefGoogle Scholar
  29. 29.
    Hammond, C. B., Borchert, L. G., Tyrey, L., Creasman, W. T., and Parker, R. T., Treatment of metastatic trophoblastic disease: good and poor prognosis, Amer. J. Obstet. Gynecol. 115:451 (1973).Google Scholar
  30. 30.
    Jones, W. B. and Lewis, J. L., Jr., Treatment of gestational trophoblastic disease, Amer. J. Obstet. Gynecol. 120:14 (1974).Google Scholar
  31. 31.
    Miller, J. M., Surwit, E. A., and Hammond, C. B., Choriocarcinoma following term pregnancy, Obstet. Gynecol. 53:207 (1979).PubMedGoogle Scholar
  32. 32.
    Djerassi, I., Methotrexate infusions and intensive supportive care in the management of children with acute lymphocytic leukemia: Follow up report, Cancer Res. 27:2561 (1967).PubMedGoogle Scholar
  33. 33.
    Bagshawe, K. D., “Choriocarcinoma,” Edward Arnold, Ltd., London (1969).Google Scholar
  34. 34.
    Hammond, C. B., Hertz, R., Ross, G. T., Lipsett, M. B., and Odell, W. D., Primary chemotherapy for nonmetastatic gestational trophoblastic neoplasms, Amer. J. Obstet. Gynecol. 98: 71 (1967).Google Scholar
  35. 35.
    Berkowitz, R. S., Goldstein, D. P., Miles, J. A., Marean, A. R., and Bernstein, M. R., Methotrexate with citrovorum factor rescue, Cancer 45:423 (1980).PubMedCrossRefGoogle Scholar
  36. 36.
    Smith, E. B., Weed, J. C., Tyrey, L., and Hammond, C. B., Treatment of nonmetastatic gestational trophoblastic disease: Results of methotrexate alone versus methotrexate-folinic acid, Amer. J. Obstet. Gynecol. 144:88 (1982).Google Scholar
  37. 37.
    Perez, C. A., Knapp, R. C., and Young, R. C., Trophoblastic tumors, in: “Cancer Principles and Practice of Oncology,” V. T. DeVita, Jr., S. Hellman, and S. A. Rosenberg, eds., Lippincott, Philadelphia (1982).Google Scholar
  38. 38.
    Goldstein, D. P. and Berkowitz, R. S., Non-metastatic and low risk metastatic gestational trophoblastic neoplasms, Semin. Oncol. 9:191 (1982).PubMedGoogle Scholar
  39. 39.
    Lewis, J., Jr., Gore, H., Hertig, A. T., and Goss, D. A., Treatment of trophoblastic disease, Amer. J. Obstet. Gynecol. 96:710 (1966).Google Scholar
  40. 40.
    Surwit, E. A., The management of poor prognosis trophoblastic disease, Semin. Oncol. 9:204 (1982).PubMedGoogle Scholar
  41. 41.
    Begent, R. H. J. and Bagshawe, K. D., The management of high risk choriocarcinoma, Semin. Oncol. 9:198 (1982).Google Scholar
  42. 42.
    Surwit, E. A., Sucio, T. N., Schmidt, H. J., et al., A new combination chemotherapy for resistant trophoblastic disease, Gynecol. Oncol. 8:110 (1979).PubMedCrossRefGoogle Scholar
  43. 43.
    Newlands, E. S. and Bagshawe, K. D., Activity of high dose cis-platinum in combination with vincristine and methotrexate in drug resistant gestational choriocarcinoma. A report of 17 cases, Brit. J. Cancer 40:943 (1979).PubMedCrossRefGoogle Scholar
  44. 44.
    Shlaerth, J. B., Morrow, C. P., and Depetrillo, A. D., Sustained remission of choriocarcinoma with cis-platinum, vinblastine and bleomycin after failure of conventional chemotherapy, Amer. J. Obstet. Gynecol. 136:983 (1980).Google Scholar
  45. 45.
    Newlands, E. S., New chemotherapeutic agents in the management of gestational trophoblastic disease, Semin. Oncol. 9:239 (1982).Google Scholar
  46. 46.
    Weed, J. C. and Hammond, C. B., Cerebral metastatic choriocarcinoam: Intensive therapy and prognosis, Obstet. Gynecol. 55:89 (1980).PubMedGoogle Scholar
  47. 47.
    Surwit, E. A. and Hammond, C. B., Treatment of metastatic trophoblastic disease with poor prognosis, Obstet. Gynecol. 55:565 (1980).Google Scholar
  48. 48.
    Weed, J. C., Woodward, K. T., and Hammond, C. B., Choriocarcinoma metastatic to the brain, therapy and prognosis, Semin. Oncol. 9:208 (1982).PubMedGoogle Scholar
  49. 49.
    Goldstein, D. P., Couch, N. P., and Hall, T. C., Infusion therapy in the treatment of patients with choriocarcinoma and related trophoblastic tumors, Surg, Forum 18:426 (1967).Google Scholar
  50. 50.
    Goldstein, D. P., Berkowitz, R. S., and Cohen, S. M., The current management of molar pregnancy, Curr. Probl. Obstet. Gynecol. 3:4 (1979).Google Scholar
  51. 51.
    Koga, K. and Maeda, K., Prophylactic chemotherapy with amethopterin for prevention of choriocarcinoam following removal of hydatidiform mole, Amer. J. Obstet. Gynecol. 100:270 (1968).Google Scholar
  52. 52.
    Fasoli, M., Ratti, E., Franceschi, S., et al., Management of gestational trophoblastic disease: Results of a cooperative study, Obstet. Gynecol. 60:205 (1982).PubMedGoogle Scholar
  53. 53.
    Goldstein, D. P., Prevention of gestational trophoblastic disease by use of actinomycin D in molar pregnancies, Obstet. Gynecol. 43:475 (1974).PubMedGoogle Scholar
  54. 54.
    Lewis, J. L., Jr., Current status of gestational trophoblastic disease, Cancer 38:620 (1976).PubMedCrossRefGoogle Scholar
  55. 55.
    Goldstein, D. P., Saracco, P., Osathanondth, R., et al., Methotrexate with citrovorum factor rescue for gestational trophoblastic neoplasms, Obstet. Gynecol. 51:93 (1978).PubMedCrossRefGoogle Scholar
  56. 56.
    Berkowitz, R. S., Goldstein, D. P., and Bernstein, M. R., Methotrexate with citrovorum factor rescue as primary therapy for gestational trophoblastic disease, Cancer 50:2024 (1982).PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1984

Authors and Affiliations

  • Alberto Sobrero
    • 1
  • Joseph R. Bertino
    • 1
  1. 1.Departments of Pharmacology and MedicineYale University School of MedicineNew HavenUSA

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