BACKGROUND: Well-established first-line chemotherapy (such as EMA-CO) is extraordinary active for gestational choriocarcinoma. However, it causes very serious situation once drug-induced acute interstitial lung disease occurs during the treatment. CASE: A 31-year-old Japanese woman with metastatic choriocarcinoma was treated with EMA-CO as an initial chemotherapy regimen for seven cycles. Her beta-hCG dropped from 13,087 ng/ml to 2.2 ng/ml. At 11 days after 7th cycle of EMA-CO treatment, however, she developed respiratory failure, and was diagnosed as having EMA-CO-induced interstitial lung disease with bilateral ground-glass opacity on CT scan, and the examination of the bronchoalveolar lavage fluid. After high-dose steroid therapy, symptoms and ground-glass opacity on CT scan were remarkably improved. She then commenced a regimen of carboplatin (AUC 5) and paclitaxel (180 mg/m2). After completing 8 cycles, her beta-hCG dropped to <0.2 ng/ml. Three additional cycles were administered and the patient remained clinically free of disease, with normal beta-hCG levels for 11 months. CONCLUSIONS: Paclitaxel and carboplatin combination is active and appears to be a viable alternative to EMA-CO combination chemotherapy in metastatic choriocarcinoma even after EMA-CO-induced interstitial lung disease.
BACKGROUND: Well-established first-line chemotherapy (such as EMA-CO) is extraordinary active for gestational choriocarcinoma. However, it causes very serious situation once drug-induced acute interstitial lung disease occurs during the treatment. CASE: A 31-year-old Japanese woman with metastatic choriocarcinoma was treated with EMA-CO as an initial chemotherapy regimen for seven cycles. Her beta-hCG dropped from 13,087 ng/ml to 2.2 ng/ml. At 11 days after 7th cycle of EMA-CO treatment, however, she developed respiratory failure, and was diagnosed as having EMA-CO-induced interstitial lung disease with bilateral ground-glass opacity on CT scan, and the examination of the bronchoalveolar lavage fluid. After high-dose steroid therapy, symptoms and ground-glass opacity on CT scan were remarkably improved. She then commenced a regimen of carboplatin (AUC 5) and paclitaxel (180 mg/m2). After completing 8 cycles, her beta-hCG dropped to <0.2 ng/ml. Three additional cycles were administered and the patient remained clinically free of disease, with normal beta-hCG levels for 11 months. CONCLUSIONS:Paclitaxel and carboplatin combination is active and appears to be a viable alternative to EMA-CO combination chemotherapy in metastatic choriocarcinoma even after EMA-CO-induced interstitial lung disease.