The efficacy and toxicity of 4-day chemotherapy with methotrexate, etoposide and actinomycin D in patients with choriocarcinoma and high-risk gestational trophoblastic neoplasia

  • Shizuka Sato
  • Eiko YamamotoEmail author
  • Kaoru Niimi
  • Kazuhiko Ino
  • Kimihiro Nishino
  • Shiro Suzuki
  • Tomomi Kotani
  • Hiroaki Kajiyama
  • Fumitaka Kikkawa
Original Article



This study aimed to evaluate the efficacy and toxicity of 4-day chemotherapy with methotrexate, etoposide, and actinomycin D (MEA) for patients who were diagnosed with choriocarcinoma and high-risk gestational trophoblastic neoplasia (GTN).


Between January 1999 and December 2015, 29 patients were treated with 4-day MEA after being diagnosed with choriocarcinoma or high-risk GTN. Complete remission to 4-day MEA and adverse effects were retrospectively evaluated.


The complete remission rates were 79.3% (23/29) and 87.5% (21/24) in all patients and in those who received 4-day MEA as first-line therapy, respectively. Of six patients who developed drug resistance to 4-day MEA, three patients showed complete remission by other treatments, while the other three patients died of the disease. The major adverse effects were leukocytopenia, anemia, and nausea. Of 23 patients who were cured with 4-day MEA, treatment was changed to the etoposide and actinomycin D (EA) regimen in 14 patients, because of leukocytopenia, hepatotoxicity, and stomatitis. Among 20 patients who required hormonal therapy, 15 patients showed normal menstrual cycles after therapy. Five patients had nine conceptions (seven term live births and two spontaneous abortions). No babies were premature or had low birth weight nor did they have congenital anomalies.


The results suggest that the efficacy and the adverse effects of 4-day MEA for choriocarcinoma and high-risk GTN may be the same level as EMA/CO. However, further study will be needed for determining the criteria of changing the treatment regimen from 4-day MEA to the EA regimen.


Actinomycin D Choriocarcinoma Etoposide High-risk gestational trophoblastic neoplasia Methotrexate 



This work was supported by JSPS KAKENHI Grant number JP17K16845.

Compliance with ethical standards

Conflict of interest

No potential conflict of interest relevant to this article was reported.


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Healthcare AdministrationNagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Department of Obstetrics and GynecologyWakayama Medical UniversityWakayamaJapan

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