How would you adjust therapy for a patient with high risk, stage III choriocarcinoma (lung mets) in the context of renal insufficiency (Cr 3.8)?

Risk score might dictate chemo regimen. There are dose adjustments for Methotrexate & Cytoxan based on renal function for MAC which you could use if risk score 7 or 8. I’d follow MTX levels & dose folinic acid until nontoxic MTX levels. If higher score I’d use EMA +/- CO. Consider neupogen on off-chemo days.

Usually, I would give EMA/EP for score >12, with 1 or 2 cycles of low dose etoposide/CDDP for induction. Given this patient's renal impairment, I'd use etoposide/carbo @ AUC = 2 for induct...