Yun J, Lee SW, Lim SH, Kim SH, Kim CK, Park SK. Successful treatment of a high-risk nonseminomatous germ cell tumor using etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine: A case report. World J Clin Cases 2020; 8(21): 5334-5340 [PMID: 33269267 DOI: 10.12998/wjcc.v8.i21.5334]
Corresponding Author of This Article
Seong K Park, MD, Professor, Department of Internal Medicine, Division of Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, 170 Jomaru-ro, Bucheon 14584, South Korea. skpark@schmc.ac.kr
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 6, 2020; 8(21): 5334-5340 Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5334
Successful treatment of a high-risk nonseminomatous germ cell tumor using etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine: A case report
Jina Yun, Sang W Lee, Sung H Lim, Se H Kim, Chan K Kim, Seong K Park
Jina Yun, Sung H Lim, Se H Kim, Chan K Kim, Seong K Park, Department of Internal Medicine, Division of Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
Sang W Lee, Department of Urology and Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
Author contributions: Yun J concentualized, acquisition fund and wrote the original draft; Park SK curated, administrated project, wrote, reviewed and edited the draft; S Kim SH investigated and analyzed form; Kim CK supported the methodology and software; Lee SW support the resources and supervision; Lim SH made the validation and visualization; all authors approved of the final manuscript.
Supported bythe Soonchunhyang University Research Fund, No. 20200011.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seong K Park, MD, Professor, Department of Internal Medicine, Division of Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, 170 Jomaru-ro, Bucheon 14584, South Korea. skpark@schmc.ac.kr
Received: May 27, 2020 Peer-review started: May 25, 2020 First decision: September 14, 2020 Revised: September 25, 2020 Accepted: October 19, 2020 Article in press: October 19, 2020 Published online: November 6, 2020 Processing time: 163 Days and 6.1 Hours
Abstract
BACKGROUND
Choriocarcinoma is an infrequent entity and the most aggressive subtype of germ-cell tumors. Because of early metastatic spread and rapid disease progression, choriocarcinoma patients display poor prognosis. Although etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) regimen is widely used to treat gestational trophoblastic tumors in females, its role in treating male choriocarcinoma is seldom reported.
CASE SUMMARY
A 32-year-old man was diagnosed with burned-out primary germ cell tumors (GCT) with retroperitoneum, liver and lung metastases. Biopsy of the liver revealed pure choriocarcinoma. The patient received bleomycin, etoposide, and cisplatin chemotherapy. After two cycles of treatment, response evaluation revealed the mixed response. EMA-CO regimen was used in the second-line therapy. After eight cycles, the patient showed a potentially resectable state and thus, all residual masses were surgically removed. The patient was completely cured, and 10 years later, he is leading a healthy life without complications.
CONCLUSION
This paper is the first case of high-risk nonseminomatous GCT in a male patient to be successfully treated with the EMA-CO regimen. The EMA-CO regimen can be used actively in patients with high-risk nonseminomatous GCT.
Core Tip: Choriocarcinoma is an extremely rare germ cell tumor and responds poorly to standard chemotherapy. Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine regimen is widely used to treat gestational trophoblastic tumors in females, however, its role in choriocarcinoma of males is seldom reported. This case report is the first of its kind demonstrating successful treatment using the etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine regimen in a male diagnosed with cisplatin-refractory high-risk nonseminomatous germ cell tumors.
