GYNECOLOGIC ONCOLOGY 65, 366–369 (1997) ARTICLE NO. GO974677 CASE REPORT Complete Remission of Refractory Gestational Trophoblastic Disease with Brain Metastases Treated with Multicycle Ifosfamide, Carboplatin, and Etoposide (ICE) and Stem Cell Rescue Koen van Besien,* ,1 Claire Verschraegen,² Rakesh Mehra,* Sergio Giralt,* Andrzej P. Kudelka,² Creighton L. Edwards,‡ Surintip Piamsonboom,§ Wichai Termrungruanglert, Ø Richard Champlin,* and John J. Kavanagh² Division of Medicine, *Department of Hematology and ² Section of Gynecologic Medical Oncology, and ‡Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030; §Siriraj Hospital, Mahidol University, Bangkok, Thailand; and Ø Chulalongkorn University Hospital, Bangkok, Thailand Received October 16, 1996 to the oncologist. First, it often affects young women and Patients with chemotherapy-refractory gestational trophoblastic can therefore cause major social and familial disruption. disease and brain metastasis are considered to have a very poor Second, this chemotherapy-sensitive tumor can often be prognosis. We present the case of a patient who had failed several cured with single-agent methotrexate or, in poor-prognosis chemotherapeutic regimens. Despite transient responses to chemo- patients, by combination chemotherapy regimens such as therapy, she had not achieved a complete remission in 3 years, EMA-CO (etoposide, methotrexate, actinomycin D, cyclo- and had developed systemic disease and recurrent brain metasta- phosphamide, vincristine) [8]. Third, the course of the dis- sis. She was treated with four cycles of high-dose ifosfamide, car- ease can be monitored by measurement of serum levels of boplatin, and etoposide with blood progenitor cell support. She b-HCG; prolonged normalization of this marker usually in- tolerated this regimen well and has obtained a complete remission dicates a cure. that is ongoing for 12 months.  1997 Academic Press A small percentage of patients fail two chemotherapy regi- mens. Some can be salvaged by third-line chemotherapy INTRODUCTION [9, 10], by surgical resection of solitary metastasis, or by irradiation of brain lesions. However, patients with multiple recurrences, especially disease that metastasizes to the brain, High-dose chemotherapy is based on the concept that in- have a poor prognosis. creasing the dose of chemotherapeutic agents produces en- hanced cytoreduction and may overcome tumor resistance [1]. Progress in supportive care has reduced the risks of high- CASE REPORT dose chemotherapy and has allowed for the administration of highly myelosuppressive regimens on an outpatient basis [2, A 31-year-old woman, gravida 2 para 2, was diagnosed 3]. The ability to collect large numbers of hematopoietic in 1989 with persistent nonmetastatic GTD, after a molar progenitors has also allowed the design of regimens that pregnancy. She achieved remission with 4 cycles of metho- include multiple cycles of high-dose chemotherapy at short trexate and folinic acid. The disease recurred 2 years later intervals [4, 5]. We present the case of a patient with gesta- and did not respond to methotrexate reinduction. She was tional choriocarcinoma that illustrates the potential for this treated with actinomycin D and achieved a complete remis- form of treatment. sion, but relapsed within 2 months. She had empiric abdomi- Gestational trophoblastic disease (GTD) is relatively rare nal hysterectomy and three cycles of cyclophosphamide, ac- [6, 7]. It has, however, several features of particular interest tinomycin D, and methotrexate (MAC) [11], but did not respond. She then received methotrexate 3.3 g/m 2 , vincris- tine 1.25 mg/m 2 , and VP-16 200 mg/m 2 alternating weekly 1 To whom reprint requests should be addressed at M.D. Anderson Cancer with bleomycin 10 mg/m 2 , 5-FU 500 mg/m 2 , and cisplatin Center, 1515 Holcombe Boulevard, Box 65, Houston, TX, 77030. Fax: (713) 794 1036. 50 mg/m 2 . She achieved another complete remission, but 366 0090-8258/97 $25.00 Copyright  1997 by Academic Press All rights of reproduction in any form reserved.