Cancer drug treatment for invasive mole and choriocarcinoma

Chemotherapy is the most common treatment for an invasive mole or choriocarcinoma.

An invasive mole is a cancer that can form in the womb after an abnormal type of pregnancy called a molar pregnancy. It is also called persistent trophoblastic disease (PTD). Choriocarcinoma is a very rare cancer that can occur after a normal pregnancy, a molar pregnancy, a miscarriage or a termination of pregnancy (abortion). 

About chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy tumour cells. They work by disrupting their growth. Chemotherapy circulates in the bloodstream around the body.

Your doctors will look at various factors to give your disease a stage and risk score. Chemotherapy treatment is different for low, high, and ultra-high risk disease. 

Your healthcare team will regularly check the level of a hormone in your blood. This is called human chorionic gonadotrophin (hCG). This tells your team how well the chemotherapy is working. You have chemotherapy until your hCG levels go back to normal and for 6 more weeks after that.

You might have a single chemotherapy drug or a combination for treatment of invasive mole or choriocarcinoma. The most common drugs are:

• methotrexate
• actinomycin D
• etoposide, methotrexate, actinomycin, cyclophosphamine, vincristine (EMA-CO)
• etoposide, cisplatin, methotrexate, actinomycin D (EP-EMA)
• paclitaxel and cisplatin or etoposide (TP/TE)

Chemotherapy for low risk invasive mole or choriocarcinoma

You usually have treatment with methotrexate if you have low risk disease. You have it as an injection into a muscle (intramuscularly) every other day for a week. 

You also take a folinic acid tablet about 30 hours after each injection. This helps to reduce the side effects of the methotrexate. 

You then have a 7 day break before the next cycle begins. 

You stay in hospital for your first week of treatment. But you can usually have the rest of your treatment as an outpatient.

If your hCG levels don't go down

If your hCG levels don't go back down to normal or they begin to go up again, it is known as methotrexate resistance. You will change chemotherapy. The drugs you have depend on your hCG levels. Your healthcare team will explain your treatment and what this involves.

Chemotherapy for high risk invasive mole or choriocarcinoma

If you have a high risk invasive mole or choriocarcinoma, you usually have a combination of chemotherapy drugs. Your healthcare team will explain your treatment and what this involves.

If your hCG levels don’t go down

If your hCG levels don't go back down to normal or they begin to go up again, you will change chemotherapy.

Chemotherapy for ultra high risk invasive mole or choriocarcinoma

If your risk score is over 13, you might have a lower dose of chemotherapy to start with. This is to lower the risk of serious side effects. This is called induction chemotherapy. 

If the cancer has spread to the brain

Some women might have disease that spreads to their brain. This is rare. In this situation, you might have treatment with methotrexate into your spinal fluid (intrathecally). Sometimes intrathecal treatment is given if you are at high risk of disease spreading to the brain.

Depending on the combinations of drugs you have, you might have some treatment as an inpatient.

Immunotherapy drug treatment

Immunotherapy drugs help your immune system to attack cancer. Although rare, some women might develop resistance to chemotherapy drugs. These women might have treatment with an immunotherapy drug called pembrolizumab (Keytruda).

Where you have chemotherapy

You have chemotherapy treatment at one of the specialist GTD centres in the UK. These are: 

• Charing Cross hospital in London 
• Weston Park hospital in Sheffield

You might be able to have some of your outpatient treatment at your local hospital, if they have a chemotherapy service. If you are having methotrexate as an injection, your GP might be able to do this. The team at your specialist centre will tell you if either of these would be possible for you.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

Side effects

Common chemotherapy side effects include:

• feeling sick
• loss of appetite
• losing weight
• feeling very tired
• a lower resistance to infections
• bleeding and bruising easily
• diarrhoea or constipation
• hair loss 
• mouth ulcers
• sore eyes
• chest pain

Side effects depend on:

• which drugs you have
• how much of each drug you have
• how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

When you go home

Chemotherapy for invasive mole or choriocarcinoma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.