No Increase in Second Tumors after Cytotoxic Chemotherapy for Gestational Trophoblastic Tumors

We investigated the incidence of second tumors after cytotoxic chemotherapy in 457 long-term survivors treated for choriocarcinoma or an invasive mole between 1958 and 1978. Treatment was given according to regular intermittent schedules and over a mean period of four months, with no maintenance. Methotrexate was given to all but two patients, and 261 (57 per cent) also received other cytotoxic drugs, most commonly dactinomycin, vincristine, cyclophosphamide, mercaptopurine, and 6-azauridine. After a mean period of 7.8 years since the beginning of treatment and a total of 3522 patient-years of risk, second neoplasms had developed in only two women (acute leukemia in one and carcinoma of the breast in the other). This figure is less than the number of cases of cancer that would have been expected (3.5) in this group and suggests that the use of methotrexate as chemotherapy for choriocarcinoma is not carcinogenic in the medium term. (N Engl J Med. 1983; 308:473–6.) Many anticancer agents are known carcinogens. There is increasing awareness that the chemotherapy or radiotherapy used to induce a long-term complete remission of one cancer may induce a second cancer. Certain drugs and drug combinations have been particularly associated with the development of second tumors; these include mustine, vincristine, procarbazine, and prednisolone for Hodgkin's disease 1 , 2 and long-term alkylating-agent therapy for myeloma, ovarian cancer, lung cancer, non-Hodgkin's lymphoma, and polycythemia rubra vera. 3 4 5 6 Apart from one cervical carcinoma in situ, 7 no second tumors have been reported to follow chemotherapy for choriocarcinoma. 8 It is possible therefore that certain drug regimens, particularly those containing . . .