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

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.

scholarly journals A case of methotrexate resistant gestational trophoblastic neoplasia

2018 ◽  
Vol 7 (12) ◽  
pp. 5178
Author(s):  
Sanjay Singh ◽  
Akhileshwar Singh ◽  
Shakti Vardhan
Keyword(s):  
High Risk ◽  
Combination Chemotherapy ◽  
Single Agent ◽  
Gestational Trophoblastic Disease ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Disease ◽  
Peripheral Hospital ◽  
Invasive Mole ◽  
Single Agent Chemotherapy

Gestational trophoblastic neoplasia (GTN) is a subset of gestational trophoblastic disease (GTD) which has a propensity to invade locally and metastasize. Patients with low risk GTN generally respond well to single agent chemotherapy (methotrexate (MTX) or actinomycin-D (ACT-D). However, high risk cases may develop resistance or may not respond to this first-line chemotherapy and are unlikely to be cured with single-agent therapy. Therefore, combination chemotherapy is used for treatment of these cases. Here we present a 25 years old P2 L2 A1 lady, who was initially treated at a peripheral hospital with multiple doses of Injection methotrexate with a working diagnosis of persistent trophoblastic disease. She didn’t respond to this treatment and reported to our centre for further management. On evaluation she was found to be a case of high risk GTN (invasive mole) (I:8) for which she was put on combination chemotherapy in the form of Etoposide-Methotrexate-Actinomycin-Cyclophosphamide-Oncovin (EMA-CO) regime. She responded to this treatment and is presently asymptomatic and is under regular follow up.

scholarly journals The Curative Effect of a Second Curettage in Low-Risk Gestational Trophoblastic Neoplasia

2020 ◽  
Vol 10 (1) ◽  
pp. 88
Author(s):  
Azar Ahmadzadeh ◽  
Mahin Najafian ◽  
Kosar Lalvand
Keyword(s):  
Drug Exposure ◽  
Endometrial Thickness ◽  
Single Agent ◽  
Low Risk ◽  
Gestational Trophoblastic Neoplasia ◽  
Kaplan Meier ◽  
Beta Hcg ◽  
Response To Chemotherapy ◽  
Time Required ◽  
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&#39; hospitalization records were also extracted from the files. Patients with an endometrial thickness above 10 mm were treated with re-curettage. The &beta; 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 &beta;-hCG clearance in patients undergoing re-curettage was significantly lower than the chemotherapy receiving group (7 months vs. 10 months, p &lt;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 &lt;0.0001). The baseline &beta;-hCG levels were significantly lower in those who did not need chemotherapy (p = 0.012). &beta;-hCG resolution occurred more rapidly in patients undergoing re-curettage alone, while, those who received only chemotherapy had a longer duration for &beta;-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 &beta;-hCG could be considered as a predictive factor in response to curettage.

scholarly journals Direct comparisons of efficacy and safety between actinomycin-D and methotrexate in women with low-risk gestational trophoblastic neoplasia: a meta-analysis of randomized and high-quality non-randomized studies

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiatao Hao ◽  
Weihua Zhou ◽  
Mengzhao Zhang ◽  
Hui Yu ◽  
Taohong Zhang ◽  
...  
Keyword(s):  
Complete Remission ◽  
Fixed Effects ◽  
Actinomycin D ◽  
Meta Analysis ◽  
Low Risk ◽  
Controlled Trials ◽  
Gestational Trophoblastic Neoplasia ◽  
Efficacy And Safety ◽  
High Quality ◽  
Significant Difference

Abstract Background Actinomycin-D (Act-D) and Methotrexate (MTX) are both effective first-line agents for low-risk gestational trophoblastic neoplasia (LRGTN) with no consensus regarding which is more effective or less toxic. The primary objective of this meta-analysis is to compare Act-D with MTX in the treatment of LRGTN. Methods We systematically searched electronic databases, conferences abstracts and trial registries for randomized controlled trials (RCTs) and high-quality non-randamized controlled trials (non-RCTs), comparing Act-D with MTX for patients with LRGTN. Studies were full-text screened for quality assessment and data extraction. Eligible studies must have reported complete remission rate. A fixed-effects meta-analysis was conducted to quantify the efficacy and safety of Act-D and MTX on odds ratios (ORs) and 95% confidence intervals (95%CIs), respectively. Results A total of 8 RCTs and 9 non-RCTs (1674 patients) were included. In terms of efficacy, Act-D is superior to MTX in complete remission (80.2% [551/687] vs 65.1% [643/987]; OR 2.15, 95%CI 1.70 to 2.73). In the stratified analysis, patients from RCTs and non-RCTs both had a better complete remission from Act-D-based regimen (RCTs: 81.2% [259/319] vs 66.1% [199/301], OR 2.17, 95%CI 1.49 to 3.16; non-RCTs: 79.3% [292/368] vs 65.0% [444/686], OR 2.14, 95%CI 1.57 to 2.92). In terms of safety, patients receiving Act-D had higher risks of suffering nausea (OR 2.35, 95%CI 1.68 to 3.27), vomiting (OR 2.40, 95%CI 1.63 to 3.54), and alopecia (OR 2.76, 95%CI 1.60 to 4.75). Notably, liver toxicity (OR 0.38, 95%CI 0.19 to 0.76) was the only one that was conformed to have a higher risk for patients receiving MTX. In addition, the pooled results showed no significant difference of anaemia, leucocytopenia, neutropenia, thrombocytopnia, constipation, diarrhea, anorexia, and fatigue between Act-D and MTX. Conclusions Our meta-analysis suggests that Act-D had better efficacy profile in general, and MTX had less toxicities in LRGTN. Future clinical trials should be better orchestrated to provide more valid data on efficacy and toxicity.

scholarly journals Direct Comparisons of Efficacy and Safety Between Actinomycin-D and Methotrexate in Women With Low-Risk Gestational Trophoblastic Neoplasia: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Jiatao Hao ◽  
Weihua Zhou ◽  
Mengzhao Zhang ◽  
Hui Yu ◽  
Taohong Zhang ◽  
...  
Keyword(s):  
Complete Remission ◽  
Fixed Effects ◽  
Actinomycin D ◽  
Remission Rate ◽  
Meta Analysis ◽  
Low Risk ◽  
Controlled Trials ◽  
Gestational Trophoblastic Neoplasia ◽  
Efficacy And Safety ◽  
Significant Difference

Abstract Background: Actinomycin-D (Act-D) and Methotrexate (MTX) are both effective first-line agents for low-risk gestational trophoblastic neoplasia (LRGTN) with no consensus regarding which is more effective or less toxic. The primary objective of this meta-analysis is to compare Act-D with MTX in the treatment of LRGTN.Methods: We systematically searched electronic databases, conferences abstracts and trial registries for randomized controlled trials (RCTs) and high-quality non-randamized controlled trials (non-RCTs), comparing Act-D with MTX for patients with LRGTN. Studies were full-text screened for quality assessment and data extraction. Eligible studies must have reported complete remission rate. A fixed-effects meta-analysis was conducted to quantify the efficacy and safety of Act-D and MTX on odds ratios (ORs) and 95% confidence intervals (95%CIs), respectively.Results: A total of 8 RCTs and 9 non-RCTs (1674 patients) were included. In terms of efficacy, Act-D is superior to MTX in complete remission (OR 2.15, 95%CI 1.70 to 2.73). In the stratified analysis, patients from RCTs and non-RCTs both had a better CR from Act-D-based regimen (RCTs: OR 2.17, 95%CI 1.49 to 3.16; non-RCTs: OR 2.14, 95%CI 1.57 to 2.92). In terms of safety, patients receiving Act-D had higher risks of suffering nausea (OR 2.35, 95%CI 1.68 to 3.27), vomiting (OR 2.40, 95%CI 1.63 to 3.54), and alopecia (OR 2.76, 95%CI 1.60 to 4.75). Notably, liver toxicity (OR 0.38, 95%CI 0.19 to 0.76) was the only one that was conformed to have a higher risk for patients receiving MTX. In addition, the pooled results showed no significant difference of anaemia, leucocytopenia, neutropenia, thrombocytopnia, constipation, diarrhea, anorexia, and fatigue between Act-D and MTX.Conclusions: Our meta-analysis suggests that Act-D had better efficacy profile in general, and MTX had less toxicities in LRGTN. Future clinical trials should be better orchestrated to provide more valid data on efficacy and toxicity.

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

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

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.

Response to Chemotherapy in Overweight/Obese Patients With Low-Risk Gestational Trophoblastic Neoplasia

2015 ◽  
Vol 25 (4) ◽  
pp. 734-740 ◽  
Author(s):  
Izildinha Maestá ◽  
Neil S. Horowitz ◽  
Donald P. Goldstein ◽  
Marilyn R. Bernstein ◽  
Luz Angela C. Ramírez ◽  
...  
Keyword(s):  
New England ◽  
Single Agent ◽  
Patient Characteristics ◽  
Low Risk ◽  
Obese Patients ◽  
Gestational Trophoblastic Neoplasia ◽  
Gynecology And Obstetrics ◽  
Response To Chemotherapy ◽  
Significant Difference ◽  
The Impact

ObjectiveDespite rising global obesity rates, the impact of obesity on gestational trophoblastic neoplasia (GTN) remains uninvestigated. This study aimed at investigating whether overweight/obesity relates to response to chemotherapy in low-risk GTN patients.MethodsThis nonconcurrent cohort study included 300 patients with International Federation of Gynecology and Obstetrics–defined postmolar low-risk GTN treated with a single-agent chemotherapy—methotrexate or actinomycin-D (actD)—between 1973 and 2012 at the New England Trophoblastic Disease Center. Chemotherapy dosing was based on actual body weight regardless of obesity status, except for 5-day courses or pulse regimens of actD. Patients were classified as overweight/obese (body mass index [BMI] ≥25 kg/m2) or non-overweight/obese (BMI <25 kg/m2). Information on patient characteristics and response to chemotherapy (need for second-line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles, need for combination chemotherapy, and time to human chorionic gonadotropin remission) was obtained.ResultsOf 300 low-risk GTN patients, 81 (27%) were overweight/obese. Overweight/obese patients were older than the non-overweight/obese patients (median age: 30 vs 28 years, P = 0.004). First-line therapy using actD was more frequent in overweight/obese patients (6.2% vs 1.4%, P = 0.036). Resistance and toxicity were similar between groups. No significant difference in the number of chemotherapy cycles needed for remission or time required to achieve remission was found between groups.ConclusionsNo association between overweight/obesity and low-risk GTN outcomes was found. Current chemotherapy dosing using BMI seems to be appropriate for overweight/obese patients with low-risk GTN.

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

2020 ◽  
Vol 159 (3) ◽  
pp. 751-757
Author(s):  
Nida Jareemit ◽  
Neil S. Horowitz ◽  
Donald P. Goldstein ◽  
Ross S. Berkowitz ◽  
Kevin M. Elias
Keyword(s):  
Single Agent ◽  
Low Risk ◽  
Gestational Trophoblastic Neoplasia ◽  
Single Agent Chemotherapy
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