Reproductive Outcomes After Gestational Trophoblastic Neoplasia. A Comparison Between Single-Agent and Multiagent Chemotherapy

Cioffi, Raffaella; Bergamini, Alice; Gadducci, Angiolo; Cormio, Gennaro; Giorgione, Veronica; Petrone, Micaela; Rabaiotti, Emanuela; Pella, Francesca; Candiani, Massimo; Mangili, Giorgia

doi:10.1097/igc.0000000000001175

Cited by 18 publications

(10 citation statements)

References 19 publications

(20 reference statements)

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“…However, we were unable to perform a sub-group analysis among women with a desire for future pregnancy. Therefore, this evidence should be interpreted with caution given that the pregnancy desire has a significant impact on the probability to attain future pregnancy 6. Of note, the recent MITO-9 study demonstrated a non-significant difference in pregnancy rate between the single- and multi-agent chemotherapy groups in women with a desire for pregnancy 6…”

Section: Discussionmentioning

confidence: 91%

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Tranoulis

Georgiou

Sayasneh

et al. 2019

Int J Gynecol Cancer

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IntroductionGestational trophoblastic neoplasia represents a rare placental malignancy spectrum that is treated with single- or multi-agent chemotherapy. This disease often impacts women of childbearing age, making post-chemotherapy fertility and obstetrical outcomes an important consideration. We aimed to ascertain the pregnancy rates and obstetric outcomes in women with gestational trophoblastic neoplasia after undergoing treatment with chemotherapy.MethodsA systematic literature review was conducted to identify studies that reported post-chemotherapy fertility and obstetric outcomes among women with gestational trophoblastic neoplasia. We performed a single-proportion meta-analysis for the outcomes of conception/pregnancy rate, term live birth rate, first and second trimester spontaneous abortions rate, stillbirth rate, premature delivery rate, and fetal/neonatal malformation rate.ResultsA total of 27 studies were included in the analysis. The median age ranged between 25.5 and 33.1 years. The pregnancy rate among women with a desire to conceive, comprising a total of 1329 women and 1192 pregnancies, was 86.7% (95% CI 80.8% to 91.6%). The term live birth rate in 6752 pregnancies was 75.84% (95% CI 73.4% to 78.2%). The adverse pregnancy outcomes were seemingly comparable to those of the general population apart from a minor increase in the stillbirth rate. The pooled proportion for the outcome of malformation rate was 1.76% (95% CI 1.3% to 2.2%). The repeat mole rate in 6384 pregnancies was 1.28% (95% CI 0.95% to 1.66%). Subsequent sub-group analysis indicated that neither multi-agent chemotherapy nor conception within 12 months post-chemotherapy increased the adverse obstetric events risk or fetal malformations.ConclusionsNearly 90% of patients desiring future fertility after chemotherapy for gestational trophoblastic disease were able to conceive. In addition, adverse pregnancy outcomes were similar to that in the general population. Multi-agent chemotherapy does not seemingly increase the malformation rate.

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Section: Discussionmentioning

confidence: 91%

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Tranoulis

Georgiou

Sayasneh

et al. 2019

Int J Gynecol Cancer

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“…Cioffi et al and Wong et al both reported a 97.5-100% rate menstrual recovery after methotrexate for low-risk gestational trophoblastic neoplasia. [31][32][33] Reports on ovarian function after single-agent actinomycin-D are more difficult to find. Most studies report on actinomycin-D in combination with other drugs or as second-line treatment after methotrexate failure.…”

Section: Fertility and Reproductive Outcomes After Single-agent Chemomentioning

confidence: 99%

“…40 Blagden et al found higher conception rates in women in the single-agent group who conceived within a year after completion of treatment, 36 while no difference in pregnancy rate between single-or multi-agent chemotherapy was found in a recent MITO-9 analysis. 31 Studies comparing pregnancies in women who conceived within 6 months after completion of chemotherapy with those who conceived later, noted a higher rate of spontaneous abortions in early conceptions. However, these studies did not separate outcomes after singleand multi-agent chemotherapy.…”

Section: Fertility and Reproductive Outcomes After Single-agent Chemomentioning

confidence: 99%

Fertility and pregnancy outcome in gestational trophoblastic disease

Joneborg

Coopmans

Trommel

et al. 2021

Int J Gynecol Cancer

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The aim of this review is to provide an overview of existing literature and current knowledge on fertility rates and reproductive outcomes after gestational trophoblastic disease. A systematic literature search was performed to retrieve all available studies on fertility rates and reproductive outcomes after hydatidiform mole pregnancy, low-risk gestational trophoblastic neoplasia, high- and ultra-high-risk gestational trophoblastic neoplasia, and the rare placental site trophoblastic tumor and epithelioid trophoblastic tumor forms of gestational trophoblastic neoplasia. The effects of single-agent chemotherapy, multi-agent including high-dose chemotherapy, and immunotherapy on fertility, pregnancy wish, and pregnancy outcomes were evaluated and summarized. After treatment for gestational trophoblastic neoplasia, most, but not all, women want to achieve another pregnancy. Age and extent of therapy determine if there is a risk of loss of fertility. Single-agent treatment does not affect fertility and subsequent pregnancy outcome. Miscarriage occurs more often in women who conceive within 6 months of follow-up after chemotherapy. Multi-agent chemotherapy hastens the natural menopause by three years and commonly induces a temporary amenorrhea, but in young women rarely causes permanent ovarian failure or infertility. Subsequent pregnancies have a high chance of ending with live healthy babies. In contrast, high-dose chemotherapy typically induces permanent amenorrhea, and no pregnancies have been reported after high-dose chemotherapy for gestational trophoblastic neoplasia. Immunotherapy is promising and may give better outcomes than multiple schedules of chemotherapy or even high-dose chemotherapy. The first pregnancy after immunotherapy has recently been described. Data on fertility-sparing treatment in placental site trophoblastic tumor and epithelioid trophoblastic tumor are still scarce, and this option should be offered with caution. In general, patients with gestational trophoblastic neoplasia may be reassured about their future fertility and pregnancy outcome. Detailed registration of high-risk gestational trophoblastic neoplasia is still indispensable to obtain more complete data to better inform patients in the future.

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“…It can influence future fertility or early menopause of women (15). The main risk factors related to GTN progression include previous molar pregnancy, within the age of 40 years and above, and Asian and American ancestry (16). Unfortunately, no comprehensive view is available with respect to epidemiological aspects, clinical features, and treatment outcomes of patients suffering from gestational trophoblastic tumors in our country.…”

Section: Resultsmentioning

confidence: 99%

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

Akhavan

Gilani

Mousavi

et al. 2019

International Journal of Women’s Health and Reproduction Scienc

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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.

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Reproductive Outcomes After Gestational Trophoblastic Neoplasia. A Comparison Between Single-Agent and Multiagent Chemotherapy

Cited by 18 publications

References 19 publications

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Gestational trophoblastic neoplasia: a meta-analysis evaluating reproductive and obstetrical outcomes after administration of chemotherapy

Fertility and pregnancy outcome in gestational trophoblastic disease

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

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