Relapse Rate of Patients with Low-Risk Gestational Trophoblastic Tumor Initially Treated With 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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Resistance to single-agent chemotherapy and its risk factors in low-risk gestational trophoblastic neoplasms

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.12613 ◽

2014 ◽

Vol 41 (5) ◽

pp. 776-783 ◽

Cited By ~ 3

Author(s):

Azam Sadat Mousavi ◽

Ashraf Zamani ◽

Faezeh Khorasanizadeh ◽

Mitra Modarres Gilani ◽

Kazem Zendehdel

Keyword(s):

Risk Factors ◽

Single Agent ◽

Low Risk ◽

Single Agent Chemotherapy

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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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Early Identification of Resistance to First-Line Single-Agent Methotrexate in Patients With Persistent Trophoblastic Disease

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.3043 ◽

2006 ◽

Vol 24 (1) ◽

pp. 52-58 ◽

Cited By ~ 22

Author(s):

Nienke E. van Trommel ◽

Leon F. Massuger ◽

Charles P. Schijf ◽

Marianne J. ten Kate-Booij ◽

Fred C. Sweep ◽

...

Keyword(s):

Characteristic Curve ◽

Single Agent ◽

Normal Serum ◽

Low Risk ◽

Control Group ◽

First Line ◽

Trophoblastic Disease ◽

Number Of Patients ◽

Central Registry ◽

Single Agent Chemotherapy

Purpose A generally accepted definition for resistance to first-line single-agent chemotherapy for persistent trophoblastic disease (PTD) is lacking. In the present study, a normogram for serum human chorionic gonadotropin (hCG) from patients with normalization of serum hCG after first-line single-agent chemotherapy for PTD was constructed to identify patients resistant to this chemotherapy. Patients and Methods Between 1987 and 2004, data from 2,132 patients were registered at the Dutch Central Registry for Hydatidiform Moles. A normal serum hCG regression corridor was constructed for 79 patients with low-risk PTD who were cured by single-agent methotrexate (MTX) chemotherapy (control group). Another group of 29 patients with low-risk PTD needed additional alternative therapies (dactinomycin and multiagent chemotherapy) for failure of serum hCG to normalize with single-agent chemotherapy (study group). Results Serum hCG measurement preceding the fourth and sixth single-agent chemotherapy course proved to have excellent diagnostic accuracy for identifying resistance to single-agent chemotherapy, with an area under the curve (AUC) for receiver operating characteristic curve analysis of 0.949 and 0.975, respectively. At 97.5% specificity, serum hCG measurements after 7 weeks showed 50% sensitivity. Conclusion In the largest study to date, we describe the regression of serum hCG levels in patients with low-risk PTD successfully treated with MTX. At high specificity, hCG levels in the first few courses of MTX can identify half the number of patients who are extremely likely to need alternative chemotherapy to cure their disease and for whom further treatment with single-agent chemotherapy will be ineffective.

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