Primary mediastinal choriocarcinoma in a woman treated with VIP therapy instead of BEP therapy for the prevention of postoperative acute respiratory distress syndrome

• Published in: International cancer conference journal 2024-10, Vol.13 (4), p.445-448
• Main Authors: Aida, Yuka, Watanabe, Ryo, Nakazawa, Kensuke, Kobayashi, Naohiro, Kawahara, Takashi, Kawai, Hitomi, Sekine, Ikuo, Hizawa, Nobuyuki
• Format: Article
• Language: English
• Subjects: Biomarkers; Bleomycin; Case report - Chemotherapy; Chemotherapy; Choriocarcinoma; Chorionic gonadotropin; Cisplatin; Computed tomography; Etoposide; Gonadotropins; Ifosfamide; Lymphatic system; Mediastinum; Medical prognosis; Medicine; Medicine & Public Health; Metastasis; Mortality; Neutropenia; Oncology; Patients; Pituitary (anterior); Prognosis; Respiratory distress syndrome; Surgery; Surgical Oncology; Tomography; Toxicity; Tumors
• ISSN: 2192-3183; 2192-3183
• DOI: 10.1007/s13691-024-00708-z

Primary mediastinal germ cell tumor (PMGCT) is an extragonadal germ cell tumor (GCT) that is classified as a poor-prognosis subtype among GCTs. Among them, choriocarcinoma accounts for 2% and its prognosis is considered to be notably poor. The standard treatment for advanced germ cell tumors is BEP therapy (bleomycin, etoposide, cisplatin), followed by surgical resection. However, treatments containing bleomycin are associated with postoperative acute respiratory distress syndrome (ARDS). We report a 38-year-old woman with locally advanced primary mediastinal choriocarcinoma. A computed tomography (CT) of the chest showed a 6.5 cm solid mass in the anterior mediastinum that had invaded the superior vena cava. Laboratory data revealed a serum total human chorionic gonadotropin (hCG) value of 298,220 mIU/mL. After one course of BEP therapy, her total hCG level decreased markedly, and the patient was switched to VIP therapy (etoposide, ifosfamide, cisplatin), a bleomycin-free regimen, to reduce the risk of ARDS. Three courses of VIP therapy and one course of salvage therapy enabled a complete surgical resection without any complications including ARDS. The patient has been disease-free for 16 months since the resection.