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

Abstract

-D), biweekly. At GTN diagnosis, patient opinion was taken into consideration when defining the initial single-agent ChT regimen, and when there was resistance or toxicity to one regimen, the other drug was used preferentially. This study was approved by the Irmandade da Santa Casa de Misericórdia de Porto Alegre Ethical Committee. RESULTS: Both groups were clinically similar (p>0.05). In first-line treatments, frequency of complete response was similar (75.7% with MTX/FA and 67.1% with bolus Act-D); the number of ChT courses -median 3 (range: 1-10) with MTX/FA and 2 (range: 1-6) with bolus Act-D -and the time to remission -median 9 weeks (range: 2-16) with MTX/FA and 10 weeks (range: 2-16) with bolus Act-D) -were not different between the groups. In both groups, first-line side effects frequency were high but intensity was low; stomatitis was higher with MTX/FA (p<0.01) and nausea and vomit with Act-D (p<0.01).Final single-agent ChT responses were high in both groups (94.8% with MTX/FA and 83.5% with bolus Act-D; p<0.01) and 13% higher in the group initially treated with MTX/FA. Rates of hysterectomy and of GTN recurrence were low and similar. No patient died due to GTN. CONCLUSION: The two regimens had similar first-line ChT response. Final single-agent response rates were high and similar in both groups but the final single-agent remission rate was higher in the MTX/FA group. Treatment of low-risk gestational trophoblastic neoplasia comparing biweekly eight-day Methotrexate with folinic acid versus bolus-dose Actinomycin-D, among Brazilian women

Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia

“…Nevertheless, there may be little or no difference between the pulsed Act-D regimen and the MTX regimen with regard to side-effects [ 9 ]. However, in a retrospective study, Uberti et al [ 19 ] discovered that first-line side effects frequency were high but intensity was low; stomatitis was higher with MTX/folinic acid ( p < 0.01) and nausea and vomiting with Act-D ( p < 0.01). In their report, nausea and vomit happened in 59.6% patients, but the severity (grading) was unclear.…”

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

“…The current first-line chemotherapeutic regimen used worldwide consists of ACT-D or MTX administered as single agents to decrease the incidence of adverse reactions to chemotherapy. In addition, CF (Uberti et al 2015) is commonly used with ACT-D. To date, the clinical efficacy and side effects of GTN chemotherapy have not been investigated. This study compared the clinical efficacy of two treatment regimens (MTX combined with CF and ACT-D) and determined factors associated with the development of resistance to each regimen in the treatment of trophoblastic tumors.…”

“…More than 90% of patients are in the low-risk group (Uberti et al 2015), which has a cure rate approaching 100% because of the development of novel drugs for GTN (a solid tumor with the highest cure rate). Cure rates as high as 90% can be achieved in patients with extensive metastases (Osborne et al 2015).…”

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

“…6,9,11,12,14,16Y22 Mean or median time to complete response or normalization of hCG for methotrexate has been reported between 5.3 to 11.8 weeks, or a treatment duration of 8.6 to 10.2 weeks. 12,16,17,19 For dactinomycin, mean or median time to complete response or normalization of hCG has been reported between 10 and 10.5 weeks, or a treatment duration of 7.6 to 8.2 weeks. 16,17,19 Given the relative chemosensitivity of low-risk GTN, secondary considerations for an optimal treatment regimen, in what is generally a young, otherwise healthy patient population, should include time to complete response, or number of cycles required, and the frequency and severity of toxicity.…”