Metastatic choriocarcinoma is considered low-risk when it is diagnosed less than four months after the onset of the pregnancy, when the ßHCG titer is less than 40,000 mIU/ml, when there are no liver or brain metastases and when there has been no previous treatment with chemotherapy .
Standard Treatment Therapy for women with low-risk metastatic GTD is usually with a single chemotherapeutic drug as for non-metastatic disease. But many physicians use only single-agent chemotherapy for women who have an abnormal postmolar ßHCG titer. All other cases with good prognostic features are treated with a combination of methotrexate + actinomycin-D + Cytoxan (MAC).
Those who fail chemotherapy with methotrexate alone (approximately 20 percent) are then treated with actinomycin-D or with MAC. MAC is given intravenously for five consecutive days every two to three weeks until the ßHCG titer returns to normal.
