scholarly journals Is Not It the Time to Change the Treatment of Intermediate-Risk Patients Suffering From Gestational Trophoblastic Neoplasia?

2019 ◽  
Vol 8 (2) ◽  
pp. 153-157
Author(s):  
Setareh Akhavan ◽  
Mitra Modarres Gilani ◽  
Azamosadat Mousavi ◽  
Sahrzad Sheikh Hasani ◽  
Fahimeh Nokhostin
Keyword(s):  
Tumor Invasion ◽  
Doppler Ultrasonography ◽  
Actinomycin D ◽  
Close Association ◽  
Single Agent ◽  
World Health ◽  
Intermediate Risk ◽  
Gestational Trophoblastic Neoplasia ◽  
Risk Scoring ◽  
Invasion Pattern

Objectives: The present study attempted to provide a clear view of gestational trophoblastic neoplasia (GTN) with the focus on resistance to treatment approaches in Iran. Materials and Methods: This retrospective cohort study reviewed the medical records of 272 patients with the definitive diagnosis of GTN referring to Imam Khomeini hospital in Tehran during 2007-2017. Results: The mean age of participants was 29.19 ± 7.46 years. The abnormal uterine bleeding (AUB) was the most common clinical manifestation in 64.3% of patients. Regarding the risk scoring condition according to the World Health Organization criteria, 77.6%, 9.1%, and 13.3% were categorized as low-, intermediate-, and high-risk cases. Single therapy with methotrexate was used in 22.8% of patients and actinomycin-D was planned for 42.3% whereas 11.0% and 1.5% were considered for treatment with the EMA-CO (Etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) and EMA-EP (Etoposide methotrexate and actinomycin-D/ etoposide and cisplatin) regimens, respectively. Good response to methotrexate was 66.7% but it was 83.6% in the ACT group (P = 0.001). The resistance to single-agent chemotherapy in low- and intermediate-risk groups was 16% and 92%, respectively. In addition, 20.2% of patients in stage one had tumor invasion pattern in the uterus in pretreatment Doppler ultrasonography, but 52% and 30% had resistance to chemotherapy treatment in invasive and noninvasive groups, respectively (P = 0.008). Conclusions: In general, due to the high resistance of the intermediate-risk subgroup to a single therapy, a combination therapy may be more useful to treat this disorder. The close association between tumor invasion pattern in the uterus in Doppler ultrasonography and drug resistance can be considered as a new criterion for tumor risk scoring.

Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy in gestational trophoblastic neoplasia

2006 ◽  
Vol 16 (3) ◽  
pp. 1432-1438 ◽  
Author(s):  
T. Turan ◽  
O. Karacay ◽  
G. Tulunay ◽  
N. Boran ◽  
S. Koc ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Survival Rate ◽  
High Risk ◽  
Actinomycin D ◽  
Single Agent ◽  
Survival Rates ◽  
Complete Response ◽  
World Health ◽  
Severe Toxicity ◽  
Gestational Trophoblastic Neoplasia

The aim of this study was to evaluate the efficacy and toxicity of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen for the treatment of high-risk gestational trophoblastic neoplasia (GTN). Thirty-three patients with high-risk GTN, scored according to World Health Organization, received 159 EMA/CO treatment cycles between 1994 and 2004. Twenty-three patients were treated primarily with EMA/CO, and 10 patients were treated secondarily after failure of single agent or MAC (methotrexate, actinomycin D, cyclophosphamide, or clorambucile) III chemotherapy. Adjuvant surgery and radiotherapy were used in selected patients. Survival, response, and toxicity were analyzed retrospectively. The overall survival rate was 90.9% (30/33). Survival rates were 91.3% (21/23) for primary treatment and 90% (9/10) for secondary treatment. Six (18.2%) of 33 patients had drug resistance. Four of them underwent surgery for adjuvant therapy. Three of these patients with drug resistance died. Survival and complete response to EMA/CO were influenced by liver metastasis, antecedent pregnancy, and histopathologic diagnosis of choriocarcinoma. Survival rate was also affected by blood group. The treatment was well tolerated. The most severe toxicity was grade 3–4 leukopenia that occurred in 24.3% (8/33) of patients and 6.9% (11/159) of treatment cycles. Febrile neutropenia occurred in one patient (3%). EMA/CO regimen is highly effective for treatment of high-risk GTN. Its toxicity is well tolerated.

Efficacy and safety of the APE (actinomycin D, cisplatin, etoposide) regimen for the management of high-risk gestational trophoblastic neoplasia.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5028-5028
Author(s):  
Catherine Lhomme ◽  
Caroline Even ◽  
Pierre Duvillard ◽  
Patricia Pautier ◽  
Anne Floquet ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Actinomycin D ◽  
Single Agent ◽  
Gestational Trophoblastic Neoplasia ◽  
Efficacy And Safety ◽  
Placental Site ◽  
Multi Agent ◽  
Figo Score

5028 Background: Patients (pts) with high risk gestational trophoblastic neoplasia (GTN) or who fail low risk single agent chemotherapy (CT) require multi agent CT to be cured. The most common regimen is etoposide (E), methotrexate and actinomycin D (A) alternating weekly with cyclophophamide and vincristine (EMA/CO). Cisplatin (P) is a very active drug but its role is controversial and usually restricted to second line. We report results of a platinum based therapy: APE. Methods: We evaluated the efficacy and safety on 103 pts treated at Institut Gustave Roussy (IGR) (n=80) or other French centers (n=23) between 1983 and 2010 with APE for high risk GTN (defined by IGR criteria [Azab, Cancer, 1988] and/or FIGO score >6). Pts with brain metastasis were excluded. Results: Efficacy was evaluated on 59 pts treated for high risk GTN in first line, and on 39 pts in >2nd line including 13 pts after multi agent CT. We excluded pts with placental site trophoblastic tumors (n=2), or with FIGO score <7 and without IGR criteria (n=3). Complete remission (CR) rate was 95%. Seven pts (7 %) relapsed and a second CR was obtained for all with surgery and/or CT. Only one patient died due to GTN, after successive CRs obtained with 3 regimens. Five year overall survival (median follow-up 6.6 years) was 98%. Toxicity was evaluated on 95 pts. No toxic death occurred. Given good efficacy and to avoid acute hematotoxicity and long-term G>1 neuro and ototoxicity APE regimen was modified as detailed in the Table (below). Long-term neuro (5 pts, G1), oto (2 pts, G1 and 2 pts, G2) and renal toxicities (1 pt, G1 ) were recorded. No long-term G2 toxicities were observed with APE3. One pt developed an AML 4 after 4cy APE and 6 cy EMA/CO. 37 pts of 40 who wished to be pregnant succeeded and all of them had at least one live birth. Conclusions: With a 98% long-term overall survival rate, an excellent reproductive outcome, and no detectable long-term toxicity, APE-3 should be regarded as an alternative standard option to EMA/CO for high-risk GTN. [Table: see text]

Five-Day Intravascular Methotrexate Versus Biweekly Actinomycin-D in the Treatment of Low-Risk Gestational Trophoblastic Neoplasia: A Clinical Randomized Trial

2016 ◽  
Vol 26 (5) ◽  
pp. 971-976 ◽  
Author(s):  
Fariba Yarandi ◽  
Azamsadat Mousavi ◽  
Fereshteh Abbaslu ◽  
Soheila Aminimoghaddam ◽  
Sepideh Nekuie ◽  
...  
Keyword(s):  
Complete Remission ◽  
Actinomycin D ◽  
Remission Rate ◽  
Single Agent ◽  
Low Risk ◽  
Multiple Drug ◽  
Gestational Trophoblastic Neoplasia ◽  
First Line ◽  
Significant Difference ◽  
Line Chemotherapy

ObjectivesMethotrexate (MTX) and Actinomycin-D (Act-D) are effective drugs used in the treatment of low-risk gestational trophoblastic neoplasia (LRGTNs). The aim of the present study was to compare intravenous (IV) MTX and IV Act-D in the treatment of LRGTNs.Materials and MethodsSixty-two patients with LRGTN were enrolled in a prospective randomized clinical trial between 2010 and 2013 in Moheb e Yas Hospital, Tehran University of Medical Sciences. Primary treatment regimens were IV MTX, 0.4 mg/kg daily for 5 days every 14 days (25 mg maximum daily dose), and IV Act-D, 1.25 mg/m2 (2 mg maximum dose) every 14 days.ResultsThirty-two and 30 patients were enrolled to MTX and Act-D groups, respectively. Complete remission after receiving first-line chemotherapy was achieved in 79% of all cases, 80% in the Act-D group and 78.1% in the MTX group.Twenty percent of the Act-D patients and 21.9% of the MTX patients showed resistance to the first-line chemotherapy, of which 16.7% and 15.6% responded completely to the second-line monotherapy, respectively. Multiple drug therapy was needed in 3.3% of the Act-D group and 6.3% of the MTX group.We did not find any correlation between treatment response and beta–human chorionic gonadotropin level, uterine mass size, lung metastasis, antecedent pregnancy, and duration from diagnosis to treatment. Adverse effects were not statistically different between the 2 groups.ConclusionsSingle-agent chemotherapy in the treatment of LRGTNs resulted in an overall complete remission rate of 79%, 80% in the Act-D group and 78.1% in MTX group, with no statistically significant difference. Whereas this study represents an important step in comparing single-agent treatments, comparison of other regimens will be required to determine the optimal single-agent therapy.

scholarly journals Gestational trophoblastic neoplasia: Retrospective analysis of clinical profile, treatment pattern and outcome

2016 ◽  
Author(s):  
Paramjeet Kaur ◽  
Ashok K. Chauhan ◽  
Anil Khurana ◽  
Yashpal Verma ◽  
Nupur Bansal
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Hydatidiform Mole ◽  
Single Agent ◽  
High Risk Group ◽  
Treatment Pattern ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Tumor ◽  
Villous Trophoblast ◽  
Invasive Mole

Background: Gestational trophoblastic disease is a spectrum of cellular proliferation arising from the placental villous trophoblast. Gestational triphoblastic neoplasia (GTN) is a collective term for GTD that invade locally or metastasize. GTD includes hydatidiform mole (complete and partial) and GTN include invasive mole, choricocarcinoma, placental site trophoblastic tumor and epitheliod trophoblastic tumor. Aim: To evaluate clinicopathological profile, treatment pattern and clinical outcome in patients with gestational trophoblastic neoplasia (GTN). Materials and Methods: Twelve cases of gestational trophoblastic neoplasia treated between 2012 to November 2015 in deptt of Radiotherapy – II, PGIMS, Rohtak were evaluated in this retrospective study. Data was analyzed on the basis of age, histopathology, stage, type of treatment received and treatment related toxicities. Disease free survival was estimated. Results: Out of 12 women 7 (58 %) had hydatidiform mole, 4 (33%) invasive mole and 01 (8%) had choriocarcinoma. All the cases were given chemotherapy. Two patients had low risk disease. Among high risk group seven patients had score of less than 7 and five patients had risk score of 7 or higher. Five patients were given single agent methotrexate, seven patients received multidrug regimens. All patients are on regular follow up. One patient (high risk group) expired as she did not receive treatment. Conclusion: GTN are rare and proliferative disorders with proper diagnosis and treatment most of the cases are amenable to treatment with favorable outcome.

Phase II trial of vinorelbine in metastatic squamous cell esophageal carcinoma. European Organization for Research and Treatment of Cancer Gastrointestinal Treat Cancer Cooperative Group.

1996 ◽  
Vol 14 (1) ◽  
pp. 164-170 ◽  
Author(s):  
T Conroy ◽  
P L Etienne ◽  
A Adenis ◽  
D J Wagener ◽  
B Paillot ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Squamous Cell ◽  
Response Rate ◽  
Single Agent ◽  
Active Agent ◽  
Dose Intensity ◽  
World Health ◽  
Who Grade ◽  
European Organization ◽  
Prior Chemotherapy

PURPOSE To evaluate the response rate and toxic effects of vinorelbine (VNB) administered as a single agent in metastatic squamous cell esophageal carcinoma. PATIENTS AND METHODS Forty-six eligible patients with measurable lesions were included and were stratified according to previous chemotherapy. Thirty patients without prior chemotherapy and 16 pretreated with cisplatin-based chemotherapy were assessable for toxicity and response. VNB was administered weekly as a 25-mg/m2 short intravenous (i.v.) infusion. RESULTS Six of 30 patients (20%) without prior chemotherapy achieved a partial response (PR) (95% confidence interval [CI], 8% to 39%). The median duration of response was 21 weeks (range, 17 to 28). One of 16 patients (6%) with prior chemotherapy had a complete response (CR) of 31 weeks' duration (95% CI, 0% to 30%). The overall response rate (World Health Organization [WHO] criteria) was 15% (CR, 2%; PR 13%; 95% CI, 6% to 29%). The median dose-intensity (DI) was 20 mg/m2/wk. VNB was well tolerated and zero instances of WHO grade 4 nonhematologic toxicity occurred. At least one episode of grade 3 or 4 granulocytopenia was seen in 59% of patients. A grade 2 or 3 infection occurred in 16% of patients, but no toxic deaths occurred. Other side effects were rare, and peripheral neurotoxicity has been minor (26% grade 1). CONCLUSION These data indicate that VNB is an active agent in metastatic esophageal squamous cell carcinoma. Given its excellent tolerance profile and low toxicity, further evaluation of VNB in combination therapy is warranted.

scholarly journals Treatment of low-risk gestational trophoblastic neoplasia comparing biweekly eight-day Methotrexate with folinic acid versus bolus-dose Actinomycin-D, among Brazilian women

2015 ◽  
Vol 37 (6) ◽  
pp. 258-265 ◽  
Author(s):  
Elza Maria Hartmann Uberti ◽  
Maria do Carmo Fajardo ◽  
Adriana Gerhardt Vieira da Cunha ◽  
Sirlene Soares Frota ◽  
Antônio Braga ◽  
...  
Keyword(s):  
Folinic Acid ◽  
Bolus Dose ◽  
Actinomycin D ◽  
Low Risk ◽  
Gestational Trophoblastic Neoplasia ◽  
Acid Versus

scholarly journals Gestational trophoblastic neoplasia: A 6 year retrospective study

2014 ◽  
Vol 03 (01) ◽  
pp. 033-037 ◽  
Author(s):  
Sushruta Shrivastava ◽  
Amal Chandra Kataki ◽  
Debabrata Barmon ◽  
Pankaj Deka ◽  
Chidananda Bhuyan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Complete Remission ◽  
Risk Score ◽  
Single Agent ◽  
Response To Treatment ◽  
Gestational Trophoblastic Neoplasia ◽  
Response To Chemotherapy ◽  
Chemotherapy Patients ◽  
Line Chemotherapy

Abstract Aims and Objectives: To study the clinical presentations of gestational trophoblastic neoplasia and its response to chemotherapy. Materials and Methods: This is a retrospective study of 28 women of gestational trophoblastic neoplasia evaluated over a period of 6 years from January 2004 to December 2009. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy, and the treatment received. All patients were scored on the basis of WHO scoring system. Patients with low risk (score </=6) received single agent chemotherapy with methotrexate or actinomycin D. Patients with high risk (score >/=7) received multiple agent chemotherapy with EMACO regimen. After completion of chemotherapy patients were followed for a minimum of 2 years. The response to treatment was evaluated during follow-up by clinical examination, beta hCG levels and imaging as and when required. Results: Out of 28 women only 27 could be evaluated, because 1 patient was lost to follow-up. Out of 27 patients, 18 patients (66.67%) achieved complete remission with the first-line chemotherapy and additional 25.92% (7/27) achieved complete remission with second line chemotherapy resulting in complete remission of 92.5% (25/27). Conclusion: Gestational trophoblastic neoplasia is curable if patient is properly evaluated and scored. It shows good response to chemotherapy.

Abstract 15764: Evaluation of Pulmonary Hypertension World Health Organization Group II in the Perioperative Setting

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Martin Marak ◽  
Danielle Tatum ◽  
Denzil Moraes
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Risk Factor ◽  
World Health Organization ◽  
Independent Risk Factor ◽  
World Health ◽  
Intermediate Risk ◽  
Surgical Risk ◽  
Group Ii ◽  
Health Organization

Introduction: The World Health Organization (WHO) categorizes pulmonary hypertension (PHTN) into 5 groups. Group II classification denotes PHTN secondary to left-heart disease and accounts for nearly 75% of all cases. However, there is limited data regarding the effect of PHTN Group II status on outcomes in the perioperative setting. Hypothesis: PHTN WHO Group II is an independent risk factor for adverse cardiopulmonary events in the perioperative setting. Methods: Retrospective review of patients who underwent intra-abdominal surgery between January 2014 - August 2019 and had previously obtained an echocardiogram. PHTN Group II was defined as estimated pulmonary artery pressure (EPAP) > 30mmHg on echocardiogram . Other forms of PHTN were excluded. Major adverse cardiovascular events (MACE) were defined as heart failure exacerbation, arrhythmia, myocardial infarction, 30 day readmission, and death. Surgical risk was categorized as low (laparoscopic) or intermediate (open). Results: By echocardiogram findings, 65 of the 178 (36.3%) patients included were Group II PHTN. Between surgical risk classes, Group II PHTN was older (mean age 73.7 years v 60.5; P< 0.01), had more comorbidities including systolic (9.70% v 21.5%, P=0.03) and diastolic (22.1% v 34.5%, P < 0.01) heart failure, and were more likely to have a MACE ( 6.2% v 43.1%, P < 0.01). PHTN Group II patients with intermediate-risk surgeries demonstrated significantly more MACE than control (11.2% v 43.7%, P <0.01) without significant difference in comorbidities. Conclusions: Group II PHTN is an independent risk factor for MACE in patients undergoing intermediate risk surgery compared to non-PHTN counterparts. Additional studies involving severity of pulmonary hypertension may provide further insight into risk stratification.

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