A Case Report: Methotrexate and Etoposide as Adjuvant Therapy on Patient with Hydatidiform Moles that Have Growing Rapidly Becomes Gestational Trophoblastic Neoplasia


  •   Supriyono


A hydatidiform mole is a type of placental abnormality that is associated with gestational trophoblastic disease (GTD). It can be complete or partial mole. They are typically considered benign, but they are also premalignant, with the potential to become malignant and invasive to other organs (gestational trophoblastic neoplasia/GTN). Management of the hydatiform moles is curettage therapy and suction, which aims to therapy and diagnostic. Follow-up post evacuation of moles must be tight with serum hCG and clinical examination. When there is evidence of vaginal bleeding and an increase in serum hCG, chemotherapy must be used as an adjuvant. This case report intends to persuade clinicians that adjuvant therapy with chemotherapy combination-based Methotrexate/MTX and etoposide can recover and eliminate vaginal bleeding disorders. On her first pregnancy, a woman of 27 years old develops a complete hydatiform mole. The curettage and suction procedure were then performed twice. She also receives chemotherapy in three series of single MTX and three series of MTX plus Etoposide. Following this therapy, the patient recovers, normal hCG level and has no vaginal bleeding problems.

Keywords: Etoposide, hCG, hydatiform mole, gestational trophoblastic neoplasia/GTN, methotrexate


Farah G, Nainggolan JD. The Controversy of Hydatidiform Mole Treatment In Women age ≥ 40 year-old. Medicinus. 2018; 6(2): 5-11.

Hosseini S, Varazgaei MY, Ebrahimi M. Effect of different doses of vitamin a on β-hcg production in patients suffering from gestational trophoblastic disease. J. Adv. Med. Biomed. Res. 2020; 28(128): 151-155.

Lund H, Vyberg M, Eriksen HH, Grove A, Jensen AØ, Sunde L. Decreasing incidence of registered hydatidiform moles in Denmark 1999–2014. Sci. Rep. 2020; 10(1): 1–10.

Kalogiannidis I, Kalinderi K, Kalinderis M, Miliaras D, Tarlatzis B, Athanasiadis A. Recurrent complete hydatidiform mole: where we are, is there a safe gestational horizon? Opinion and mini-review. J. Assist. Reprod. Genet. 2018; 35(6): 967-973.

Zakaria A, Hemida R, Elrefaie W, Refaie E. Incidence and outcome of gestational trophoblastic disease in lower Egypt. Afr. Health Sci. 2020; 20(1): 73–82.

Mulisya O, Roberts DJ, Sengupta ES, Agaba E, Laffita D, Tobias T, et al. Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital. Obstet. Gynecol. Int. 2018; 2018.

Tobing M, Arabia F, Hidayat Y, Mantilidewi K. Relationship of histopathological representation of excessive proliferation of trophoblast cells with the possibility of malignant events after complete hydatidiform mole. Int. J. Gen. Med. 2021; 14: 1899–1904.

Hidayat R, Riviati N. Sarcopenia from Pathophysiology to Clinical : Literature Review. Biomed. J. Indones. 2021; 7(1): 125–140.

Soper JT. Gestational Trophoblastic Disease: Current Evaluation and Management. Obstet. Gynecol. 2021; 137(2): 355–370.

Anyanwu M, Bah K. A cross sectional descriptive study on hydatidiform mole at Gambian tertiary hospital. Women’s Heal. 2020; 9(1): 1-5.

May T, Goldstein DP, Berkowitz RS. Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia. Chemother. Res. Pract. 2011; 2011: 1–12.

Braga A, Mora P, de Melo AC, Nogueira-Rodrigues A, Amim-Junior J, Rezende-Filho J, et al. Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide. World J. Clin. Oncol. 2019; 10(2): 28–37.

Alobaid A, Ahmeed S, Abuzaid M, Aldakhil L, Abu-Zaid A. Low-risk gestational trophoblastic neoplasia: A single-center experience from Saudi Arabia. Avicenna J. Med. 2019; 9(3): 89–93.

Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, et al. Update on the diagnosis and management of gestational trophoblastic disease. Int. J. Gynecol. Obstet. 2018; 143: 79–85.

Candelier JJ. The hydatidiform mole. Cell Adhes. Migr. 2016; 10: (1-2): 226–235.

Berkowitz RS, Goldstein DP. Current advances in the management of gestational trophoblastic disease. Gynecol. Oncol. 2013; 128(1): 3–5.

Kanno T, Matsui H, Akizawa Y, Usui H, Shozu M. Treatment results of the second-line chemotherapy regimen for patients with low-risk gestational trophoblastic neoplasia treated with 5-day methotrexate and 5-day etoposide. J. Gynecol. Oncol. 2018; 29(6): 6–13.

Koźmiński P, Halik PK, Chesori R, Gniazdowska E. Overview of dual-acting drug methotrexate in different neurological diseases, autoimmune pathologies and cancers. Int. J. Mol. Sci. 2020; 21(10).

Qiu Q, Zheng X. Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors. All Life. 2020; 13(1): 569–576.

Kluska M, Woźniak K. Natural polyphenols as modulators of etoposide anti-cancer activity. Int. J. Mol. Sci. 2021; 22(12).


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How to Cite
Supriyono. (2022). A Case Report: Methotrexate and Etoposide as Adjuvant Therapy on Patient with Hydatidiform Moles that Have Growing Rapidly Becomes Gestational Trophoblastic Neoplasia . European Journal of Medical and Health Sciences, 4(1), 4–7. https://doi.org/10.24018/ejmed.2022.4.1.1116