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CA: A Cancer Journal for Clinicians, Vol 23, 244-255, Copyright © 1973 by American Cancer Society

Chemotherapy of Choriocarcinoma and Related Trophoblastic Tumors in Women

Since fetal and maternal tissues are found to require high amounts of folic acid for their normal metabolism, the therapeutic potential of the folic acid antagonist, 4-amino-N¹⁰ methyl pteroylglutamic acid (Methotrexate) in the treatment of choriocarcinoma and related trophoblastic tumors has been studied in 27 women. These patients were treated according to a highly intensive regimen, in which certain toxic hazards were present. Therapeutic indexes included (a) serial X-rays, (b) physical findings reflecting pelvic, cerebral, and pulmonary involvement, and (c) frequent quantitative determination of the urinary excretion of chorionic gonadotropic hormone.

Remissions varying from 29 to two months have been induced in all but one patient who had received more than one course of therapy. In five patients these continuing remissions are attended by no radiologic, physical, or hormonal evidence of residual disease. In 11 patients showing an initial remission, Methotrexate resistance has been encountered with varying manifestations of persistent or progressive disease. Six patients initially responded but subsequently developed resistance to Methotrexate and died. One patient died of drug toxicity during remission, and drug toxicity may have contributed to the death of two other severely debilitated patients.

These experiences demonstrate that metastatic trophoblastic disease is susceptible to treatment and that significant clinical remissions may be obtained. Hence, although the chemotherapeutic regimen is somewhat hazardous, the morbidity and mortality may be regarded as acceptable.

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