Minimally aggressive gestational trophoblastic neoplasm (treated residual disease with hCG
The USA hCG Reference Service has identified one way to force most cases of minimally aggressive disease, disease with total hCG less than 1000 mIU/ml in serum, to respond appropriately to chemotherapy. Allow disease to advance with no therapy. When disease has advanced by itself so that patient has serum total hCG of greater than 3,000 mIU/ml, treat with EMA-CO or EMA-EP combination chemotherapy.
The USA hCG Reference Service has shown that when disease advances so that total hCG is greater than 3,000 mIU/ml, hyperglycosylated hCG rises to over 40% of total hCG. As such, disease must be growing and invading faster. As such disease then responds to chemotherapy. The USA hCG Reference Service has suggested this protocol in 29 cases. Five cases did not complete the protocol of allowing disease to advance to 3,000 mIU/ml. In three of these cases this was because of the appearance of metastases, in one case for religous reasons and in one case because the patient died from pulmonary thrombosis as a complication of bleomycin chemotherapy. Of the 24 cases that completed the protocol 24 cases responded to combination chemotherapy.