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

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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Treatment of nonmetastatic and metastatic low-risk gestational trophoblastic neoplasia: Factors associated with resistance to single-agent methotrexate chemotherapy

Gynecologic Oncology ◽

10.1016/j.ygyno.2012.03.039 ◽

2012 ◽

Vol 125 (3) ◽

pp. 572-575 ◽

Cited By ~ 43

Author(s):

Eloise Chapman-Davis ◽

Anna V. Hoekstra ◽

Alfred W. Rademaker ◽

Julian C. Schink ◽

John R. Lurain

Keyword(s):

Single Agent ◽

Low Risk ◽

Gestational Trophoblastic Neoplasia ◽

Factors Associated ◽

Methotrexate Chemotherapy

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

Gynecologic Oncology ◽

10.1016/j.ygyno.2020.09.046 ◽

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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Bortezomib administration is a risk factor associated with the development of tumor lysis syndrome in male patients with multiple myeloma: A retrospective study

10.21203/rs.3.rs-22557/v4 ◽

2020 ◽

Author(s):

Masahiro Kondo ◽

Yuji Hotta ◽

Karen Yamauchi ◽

Akimasa Sanagawa ◽

Hirokazu Komatsu ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

Odds Ratio ◽

Tumor Lysis Syndrome ◽

Low Risk ◽

Novel Therapies ◽

Tumor Lysis ◽

Factors Associated ◽

Increased Risk ◽

Male Patients

Abstract Background: Novel agents such as proteasome inhibitors have been developed for several years to treat multiple myeloma. Although multiple myeloma is a low-risk disease for developing tumor lysis syndrome (TLS), treatment with these novel therapies might increase TLS risk. Previous studies, mostly case reports or case series, have reported bortezomib-induced TLS in patients with multiple myeloma. This study aimed to investigate risk factors associated with TLS development in multiple myeloma patients.Methods: We retrospectively investigated incidences of laboratory and clinical TLS (LTLS and CTLS, respectively) in patients who received primary therapy for treatment-naive, symptomatic multiple myeloma between May 2007 and January 2018. We used multivariate logistic regression analyses to evaluate the associations between TLS and several parameters previously reported to be associated with increased risk.Results: This study included 210 patients with multiple myeloma, of which ten (4.8%) had LTLS and seven (3.3%) had CTLS. The characteristics of the administered anticancer or prophylactic antihyperuricemic agents were similar between patients with and without TLS. Multivariate analyses revealed that TLS was most strongly associated with bortezomib-containing therapy (odds ratio = 3.40, P = 0.069), followed by male sex (odds ratio = 2.29, P = 0.153). In a subgroup analysis focused on men, treatment with bortezomib-containing therapy was significantly associated with increased risk of TLS (odds ratio = 8.51, P = 0.046).Conclusion: In the present study, we investigated the risk factors associated with TLS development in 210 multiple myeloma patients, which, to the best of our knowledge, is the largest number of patients reported to date. Furthermore, this study is the first to evaluate TLS risk factors in MM by adjusting for the effects of potential confounding factors in patients’ backgrounds. Consequently, we found that bortezomib-containing therapy increases the risk of TLS in male patients with multiple myeloma. TLS risk should be evaluated further in low-risk diseases such as multiple myeloma, since a significant number of novel therapies can achieve high antitumor responses.

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