Effects of Single-Agent and Combination Chemotherapy for Gestational Trophoblastic Tumors on Risks of Second Malignancy and Early Menopause

Abstract

Subsequent cancer risks for patients cured of gestational trophoblastic tumors with modern chemotherapy appear similar to those of the normal population with no overall increased risk of malignancy after MTX-FA or EMA-CO. However, there was evidence of an increased risk of leukemia after EMA-CO and some evidence of other site-specific increased risks based on small patient numbers. All major treatments except MTX-FA increased the risk of early menopause.

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

“…Early pregnancy could compromise post-chemotherapy surveillance, posing challenges in trying to distinguish between a new pregnancy event and disease relapse. The cytotoxic agents have been associated with mutagenic and teratogenic effects 3. Chemotherapy can induce chromosomal aberrations during the pre-ovulatory oogenesis phase II oocytes 3.…”

“…The cytotoxic agents have been associated with mutagenic and teratogenic effects 3. Chemotherapy can induce chromosomal aberrations during the pre-ovulatory oogenesis phase II oocytes 3. The maturation of the recruited oocytes may last >6 months 3.…”

“…Chemotherapy can induce chromosomal aberrations during the pre-ovulatory oogenesis phase II oocytes 3. The maturation of the recruited oocytes may last >6 months 3. There should be a relatively long interval between chemotherapy completion and the first subsequent pregnancy to allow ovaries to repair or undergo regeneration, reducing thus the first/second trimester spontaneous abortion or malformation rate.…”

Efficacy and Safety of Second-Line 5-Day Dactinomycin in Case of Methotrexate Failure for Gestational Trophoblastic Neoplasia

“…6 Alopecia, which was thought to be more frequent with dactinomycin protocols, is rare in our study, with no grade 3 adverse effect. 5 This toxicity is incomparable with that of EMA-CO. 20 Because all patients will be cured by third-line treatment, trying to spare multichemotherapy regimen by using second-line dactinomycin can be discussed with patients in case of methotrexate failure, regardless of hCG level, as long as the interval between antecedent pregnancy and methotrexate initiation is shorter than 7 months.…”

PD-L1 Expression in Premalignant and Malignant Trophoblasts From Gestational Trophoblastic Diseases Is Ubiquitous and Independent of Clinical Outcomes

“…7 These treatments are characterized by acute (eg, alopecia, asthenia, myelotoxicity, and renal impairment) and long-term adverse effects (eg, myelodysplasia, leukemia, and infertility). 4,8 Finally, some women who undergo this regimen die because of insufficient efficacy of multiagent chemotherapy, especially to treat postterm trophoblastic neoplasia.…”