Outcomes for relapsed versus resistant low risk gestational trophoblastic neoplasia following single-agent chemotherapy

Background: Gestational trophoblastic neoplasia (GTN), despite its widespread metastases, is a very common cancer in women that is curable. Although the GTN cases show a good response to chemotherapy, in an effort to reduce toxic drug exposure, the second curettage has been suggested for some patients. In the current study, we have aimed to compare the benefits of the second curettage in comparison with single-agent chemotherapy for low-risk GTN patients. Methods: This retrospective observational study was carried out on GTN patients admitted to the gynecology department of Imam Khomeini Hospital in Ahvaz. The demographic profile of all participants was extracted. Patients' hospitalization records were also extracted from the files. Patients with an endometrial thickness above 10 mm were treated with re-curettage. The β hCG clearance time was estimated by the Kaplan Meier plot. Results: In the present study, 148 patients with low-risk GTN stage 1 were studied. The time required for β-hCG clearance in patients undergoing re-curettage was significantly lower than the chemotherapy receiving group (7 months vs. 10 months, p <0.0001). More than 50% of patients treated by re- curettage without needing chemotherapy. Moreover, the other 50% cases needed chemotherapy the number of courses was significantly lower than those received single-agent chemotherapy alone (p <0.0001). The baseline β-hCG levels were significantly lower in those who did not need chemotherapy (p = 0.012). β-hCG resolution occurred more rapidly in patients undergoing re-curettage alone, while, those who received only chemotherapy had a longer duration for β-hCG clearance. Conclusion: In general, the findings of this study showed that re-curettage could be used effectively in the treatment of GTN following molar pregnancy. This treatment reduces or eliminates the need for chemotherapy. Our findings also showed that the initial level of β-hCG could be considered as a predictive factor in response to curettage.

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Monotherapy for Low-Risk Gestational Trophoblastic Neoplasia with score 5-6

10.21203/rs.3.rs-1110494/v1 ◽

2021 ◽

Author(s):

Li Kemin ◽

Zhang Mengpei ◽

Yin Rutie ◽

Li Zhengyu

Keyword(s):

Drug Resistance ◽

Combination Chemotherapy ◽

Prognostic Score ◽

Single Agent ◽

Low Risk ◽

Gestational Trophoblastic Neoplasia ◽

Efficacy And Safety ◽

Significant Difference ◽

Β Hcg ◽

Single Agent Chemotherapy

Abstract Objective To investigate efficacy and safety of monotherapy in low-risk gestational trophoblastic neoplasia (GTN) patients with a high FIGO/WHO prognostic score of 5–6. Methods The low-risk GTN patients with a high FIGO/WHO prognostic score of 5–6 from January 2012 to December 2019 were enrolled. The study is a retrospective report. Real-world data were used to analyze the efficacy and safety of single-agent chemotherapy and combination chemotherapy in patients with a high FIGO/WHO prognostic score of 5–6. Results A total of 224 patients were enrolled, including 75 cases (33.5%) with a FIGO/WHO prognostic score of 5–6. Complete remission was in all patients. Among the 29 cases with a FIGO/WHO prognostic score of 5–6 taking single-agent chemotherapy, 22 cases (75.9%) developed drug resistance, the number of chemotherapy courses was 7.8±2.1, and the number of chemotherapy courses required for β-hCG to return to normal was 5.4±1.8. Among the 46 cases taking combination chemotherapy, 7 patients (15.2%) developed drug resistance, the number of chemotherapy courses was 7.4±2.0, and the number of chemotherapy courses required for β-hCG to return to normal was 4.8±1.6. There was a statistically significant difference in the drug resistance rate between these two subgroups (P < 0.05), but there was not statistically significant difference in the total number of chemotherapy courses or number of chemotherapy courses required for β-hCG to return to normal (<2mIU/ml) (P < 0.05). Conclusion Monotherapy showed remarkable advantages in low-risk GTN patients with a FIGO/WHO prognostic score of 5–6.

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Efficacy and Risk Factors Associated to Resistance to Single-Agent Chemotherapy in Low-Risk Gestational Trophoblastic Neoplasia

Open Journal of Obstetrics and Gynecology ◽

10.4236/ojog.2016.61006 ◽

2016 ◽

Vol 06 (01) ◽

pp. 50-55

Author(s):

Mamour Gueye ◽

Mame Diarra Ndiaye-Gueye ◽

Serigne Modou Kane-Gueye ◽

Fatou Niass Dia ◽

Aissatou Thiam ◽

...

Keyword(s):

Risk Factors ◽

Single Agent ◽

Low Risk ◽

Gestational Trophoblastic Neoplasia ◽

Factors Associated ◽

Single Agent Chemotherapy

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Response to first-line single agent chemotherapy impacts subsequent response to second-line therapy in low-risk gestational trophoblastic neoplasia

Gynecologic Oncology ◽

10.1016/j.ygyno.2020.06.050 ◽

2020 ◽

Vol 159 ◽

pp. 24

Author(s):

N. Jareemit ◽

N.S. Horowitz ◽

R.S. Berkowitz ◽

K.M. Elias

Keyword(s):

Single Agent ◽

Low Risk ◽

Gestational Trophoblastic Neoplasia ◽

Second Line ◽

First Line ◽

Second Line Therapy ◽

Line Therapy ◽

Subsequent Response ◽

Single Agent Chemotherapy

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Relapse rate of patients with low-risk gestational trophoblastic tumor initially treated with single-agent chemotherapy

Gynecologic Oncology ◽

10.1016/j.ygyno.2004.11.011 ◽

2005 ◽

Vol 96 (3) ◽

pp. 616-620 ◽

Cited By ~ 47

Author(s):

Hideo Matsui ◽

Kiyomi Suzuka ◽

Koji Yamazawa ◽

Naotake Tanaka ◽

Akira Mitsuhashi ◽

...

Keyword(s):

Relapse Rate ◽

Single Agent ◽

Low Risk ◽

Trophoblastic Tumor ◽

Single Agent Chemotherapy

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Etoposide-Actinomycin as Salvage Regimen for the Treatment of Nonmetastatic and Low-Risk Metastatic Gestational Trophoblastic Neoplasia: Experience at the Philippine General Hospital

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000685 ◽

2016 ◽

Vol 26 (5) ◽

pp. 977-983 ◽

Cited By ~ 3

Author(s):

Mariel S. Nevado-Gammad ◽

Agnes L. Soriano-Estrella

Keyword(s):

General Hospital ◽

Remission Rate ◽

Single Agent ◽

Salvage Chemotherapy ◽

Normal Serum ◽

Salvage Treatment ◽

Low Risk ◽

Gestational Trophoblastic Neoplasia ◽

Salvage Regimen ◽

Trophoblastic Diseases

ObjectivesSingle-agent chemotherapy has been the standard of treatment for nonmetastatic and metastatic low-risk gestational trophoblastic neoplasia (GTN). However, it is estimated that approximately 12% to 32% of patients given single-agent therapy will require a change of chemotherapy regimen because of drug resistance and/or intolerable toxicity. The Section of Trophoblastic Diseases of the Philippine General Hospital started using the combination of etoposide-actinomycin (EA) as salvage chemotherapy in the early 2000s. This study was carried out to describe the local experience with this salvage chemotherapy.Materials and MethodsThis is a retrospective descriptive study aimed to analyze the efficacy and safety of the EA regimen as salvage treatment for the management of nonmetastatic and low-risk metastatic GTN. Records of the Section of Trophoblastic Diseases of the Philippine General Hospital from January 1, 2002 to June 30, 2014 were reviewed to identify all patients who had a diagnosis of nonmetastatic and metastatic low-risk GTN. Primary remission rate and toxicity profile of all patients who received the EA regimen as salvage treatment were determined.ResultsDuring the study period, a total of 67 cycles of the EA regimen were administered to 15 patients as salvage chemotherapy. Patients received a median of 4 cycles of EA, attaining normal serum beta human chorionic gonadotropin after 2 to 3 cycles. Thirteen of the 15 patients achieved complete remission with the EA regimen, giving a remission rate of 87%. The major toxicity that the patients experienced was myelosuppression. Grade 1/2 anemia was addressed by blood transfusion. Grade 3 neutropenia/myelosuppression was addressed by the administration of granulocyte colony-stimulating factor. Alopecia was seen in all of the patients. One patient experienced dermatitis with accompanying myelosuppression.ConclusionThe EA regimen was efficacious and well tolerated for the treatment of refractory nonmetastatic and low- risk metastatic GTN.

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Power Doppler Quantification in Assessing Gestational Trophoblastic Neoplasia

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0041-111065 ◽

2016 ◽

Vol 39 (02) ◽

pp. 206-212 ◽

Cited By ~ 1

Author(s):

Yuanwei Li ◽

Meng Tang ◽

Roshan Agarwal ◽

Daksha Patel ◽

Robert Eckersley ◽

...

Keyword(s):

Doppler Ultrasound ◽

Single Agent ◽

Power Doppler ◽

Roc Curves ◽

Low Risk ◽

Gestational Trophoblastic Neoplasia ◽

Power Doppler Ultrasound ◽

Non Invasive ◽

Resistant Group ◽

Methotrexate Chemotherapy

Abstract Purpose The FIGO score cannot accurately stratify low-risk gestational trophoblastic neoplasia (GTN) patients who develop chemoresistance to single agent methotrexate chemotherapy. Tumour vascularisation is a key risk factor and its quantification may provide non-invasive way of complementing risk assessment. Materials and Methods 187 FIGO-staged, low-risk GTN patients were prospectively recruited. Power Doppler ultrasound was analysed using a quantification program. Four diagnostic indicators were obtained comprising the number of colour pixels (NCP), mean dB, power Doppler quantification (PDQ), and percentage of colour pixels (%CP). Each indicator performance was assessed to determine if they could distinguish the subset of low-risk patients who became chemoresistant. Results There were 111 non-resistant and 76 resistant patients. NCP performed best at distinguishing these two groups where the non-resistant group had an average 3435 (± 2060) pixels and the resistant group 6151 (± 3192) pixels (p < 0.001). PDQ and %CP showed significant differences (p < 0.001) but had poorer performance (area under ROC curves were 72 % and 67 % respectively compared with 75 % for NCP). The mean dB index was not significantly different (p = 0.133). Conclusion Power Doppler ultrasound quantification shows potential for non-invasive assessment of tumour vascularity and can distinguish low-risk GTN patients who become chemoresistant from those who have an uncomplicated course with first line treatment.

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Low-Risk Gestational Trophoblastic Neoplasia in Manitoba: Experience With Alternating Methotrexate and Dactinomycin

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001347 ◽

2018 ◽

Vol 28 (8) ◽

pp. 1448-1452 ◽

Cited By ~ 1

Author(s):

Vanessa Carlson ◽

Leslea Walters ◽

Pascal Lambert ◽

Erin Dean ◽

Robert Lotocki ◽

...

Keyword(s):

Single Agent ◽

Treatment Protocol ◽

Low Risk ◽

Descriptive Statistics ◽

Event Analysis ◽

Gestational Trophoblastic Neoplasia ◽

Time To Event ◽

Grade 3 ◽

Multiagent Chemotherapy ◽

Experienced Grade

ObjectivesThe aim of this study was to review the treatment and outcomes of low-risk gestational trophoblastic neoplasia (GTN) in Manitoba over more than 3 decades, with a focus on those treated with alternating methotrexate and dactinomycin, a protocol that has only rarely been described.Materials and MethodsWe retrospectively reviewed all patients with GTN referred to CancerCare Manitoba from January 1977 to December 2012. Cases were classified as low risk as per the modified WHO-FIGO prognostic scoring system (score, ⩽6). Demographic, treatment, and outcomes data were abstracted, and descriptive statistics and time-to-event analysis were performed. The low-risk protocol used at CancerCare Manitoba consists of alternating single-agent use of methotrexate and dactinomycin, each for 5 days, on a 14-day cycle.ResultsSixty-seven cases of GTN were identified, of which 52 were low risk. Thirty-nine patients were initiated on alternating methotrexate and dactinomycin. Thirty-four (87.2%) achieved primary cure on this regimen, with a median of 4.4 cycles administered (range, 2–7). Median time to response was 56 days. One patient achieved cure after receiving a repeat course of methotrexate as their final cycle. Second-line multiagent chemotherapy was required by 4 patients. Two patients experienced grade 3 toxicities, and none greater than grade 3. There were no recurrences.ConclusionsAlternating methotrexate and dactinomycin is an effective treatment protocol for low-risk GTN, with high rates of primary cure and acceptable toxicity.

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