From the Guidelines
Choriocarcinoma is a highly curable malignancy with cure rates approaching 100%, and its primary treatment involves chemotherapy, with or without surgery, as outlined in the NCCN clinical practice guidelines in oncology, version 2.2019 1. The disease is a type of gestational trophoblastic neoplasia (GTN) that arises from abnormal placental tissue and can occur after any type of pregnancy. Key characteristics of choriocarcinoma include:
- Rapidly dividing cells with potential for metastasis
- Development from gestational tissue with locally invasive or metastatic potential
- Higher incidence reported in Asia compared to Europe and North America, with an approximate incidence of one in every 1,000 pregnancies in the United States 1 Treatment approaches for choriocarcinoma are guided by risk stratification, with low-risk disease typically managed with methotrexate and high-risk disease requiring combination chemotherapy regimens such as EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine). Some important considerations in the management of choriocarcinoma include:
- Monitoring of beta-hCG levels to assess response and detect recurrence
- Potential need for surgery in cases of resistant disease or to control bleeding
- Avoidance of pregnancy during treatment and for about one year afterward to prevent confusion in monitoring disease status
- Fertility preservation is often possible with appropriate treatment, as cure rates are high and treatment typically allows for preservation of reproductive function 1
From the Research
Definition and Treatment of Choriocarcinoma
- Choriocarcinoma is a rare form of malignant trophoblastic disease 2.
- The mainstay of treatment for metastatic choriocarcinoma is systemic polychemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA/CO) 2, 3, 4.
- Other chemotherapy regimens, such as etoposide monotherapy, may also be effective in selected patients with oligometastatic choriocarcinoma 2.
EMA/CO Regimen and Its Effectiveness
- The EMA/CO regimen has been shown to be effective in treating high-risk nonseminomatous germ cell tumors, including choriocarcinoma 3, 4.
- A case report demonstrated the successful treatment of a high-risk nonseminomatous germ cell tumor using the EMA/CO regimen, with the patient achieving a complete cure and remaining healthy 10 years later 3.
- Another case report showed that the EMA/CO regimen can be used to treat patients with high-risk gestational trophoblastic neoplasia, with the patient achieving complete remission after 7 courses of chemotherapy 4.
Alternative Treatment Options
- Immunotherapy with pembrolizumab has been shown to be effective in treating recurrent metastatic choriocarcinoma that is resistant to chemotherapy 5.
- A case report demonstrated the successful retreatment of a patient with recurrent metastatic choriocarcinoma using single-agent pembrolizumab, with the patient achieving a complete response and remaining disease-free for over 24 months 5.
- The EMA/EP regimen, which includes etoposide, methotrexate, actinomycin-D, etoposide, and cisplatin, has also been shown to be effective in treating resistant gestational trophoblastic disease 6.