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Abstract
In 63 women with metastatic trophoblastic disease, intensive chemotherapy with the
folic acid antagonist amethopterin supplemented in some by vincaleukoblastine, an
oncolytic plant alkaloid, has led to complete remission in 30 patients who have been
free of hormonal, radiological, or physical evidence of residual disease for from
6 months to 5 years. Seven patients now in incomplete remission continue on treatment.
In addition, of the 26 patients who have died, 22 had obtained substantial but incomplete
remission. Such remissions were characterized by marked suppression of tumor, in many
instances leaving a persistently elevated hormone titer as the only evidence of persistent
disease. Such incomplete remissions have lasted from 1 month to more than 43 months.
The hazards of toxicity attendant upon this intensive form of chemotherapy may be
largely obviated by proper case selection, by less intensive therapy in patients with
liver or renal impairment, and by adequate supportive medical and nursing care, thus
rendering the risk involved clinically acceptable.
The highly variable clinical course of choriocarcinoma and related trophoblastic disease,
with its indeterminate frequency of spontaneous regression, renders an exact appraisal
of therapeutic accomplishment very difficult. However, the present data clearly establish
the substantial therapeutic value of intensive chemotherapy in women with metastatic
tumors of trophoblastic origin.
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© 1961 Published by Elsevier Inc.
