Efficacy of Oral Vitamin A in Reducing β-hCG Levels in Low-Risk Gestational Trophoblastic Neoplasia Patients

Abstract

Objective: Low-risk gestational trophoblastic neoplasia (GTN) is generally treated with single agent chemotherapy and methotrexate (MTX) as a first-line therapy. Vitamin A helps to increase trophoblast cell regression, as well as to decrease β-hCG levels. Vitamin A also increases the effectiveness of MTX by inducing more malignant cell death than MTX alone. Therefore, the aim of the current study was to analyze the changes in β-hCG levels in low-risk GTN patients following vitamin A administration. Methods: This study was a randomized clinical trial, which examined initial serum vitamin A and β-hCG levels in GTN patients before and after three cycles of MTX therapy. Patients were given vitamin A supplementation of 6,000 IU (1.8 mg RAEs) per day, and the changes in serum β-hCG were observed after three cycles. Patients were grouped by β-hCG levels (decreased or stagnant). Results: A total of 32 low-risks GTN patients were divided into the intervention group (16 patients who received vitamin A supplementation) and the control group (16 patients who did not receive vitamin A supplementation). In the intervention group, the average initial β-hCG level was 170,949.3 ± 354,452.1 mIU/mL, and the average β-hCG post-cycle level was 1,611.9 ± 3,652.5 mIU/mL. In the control group, the average initial β-hCG level was 178,834.1 ± 2913844.6 mIU/mL, and the average β-hCG post-cycle level was 25,388.5 ± 58,437.7 mIU/mL. Conclusion: In patients with low-risk GTN who underwent MTX chemotherapy, the levels of β-hCG and the incidence of chemo resistance in the intervention group were lower than those in the control group. Older age may also influence the incidence of chemo resistance in GTN patients. Oral administration of 6,000 IU vitamin A could help to reduce β-hCG levels in low-risk GTN patients who receive MTX chemotherapy.

The current situation of health services for hydatidiform mole in Cambodia

“…The estimated incidence of hydatidiform mole and GTN in Cambodia was lower than that in neighboring countries. The incidence of hydatidiform mole (per 1000 pregnancies or 1000 deliveries) was reported as 1.9 in Vietnam, 15 1.70 in Thailand, 21 1.8 in Thai‐Myanmar border, 22 2.8 in Malaysia, 23 2.3 in Indonesia, 24 and 2.4 in the Philippines 25 . The incidence of GTN (per 100 000 pregnancies or 100 000 deliveries) was 100 in Thailand 26 and 121 in Indonesia, 24 although fewer studies on GTN were reported compared to studies on hydatidiform mole.…”

“…The incidence of hydatidiform mole (per 1000 pregnancies or 1000 deliveries) was reported as 1.9 in Vietnam, 15 1.70 in Thailand, 21 1.8 in Thai‐Myanmar border, 22 2.8 in Malaysia, 23 2.3 in Indonesia, 24 and 2.4 in the Philippines 25 . The incidence of GTN (per 100 000 pregnancies or 100 000 deliveries) was 100 in Thailand 26 and 121 in Indonesia, 24 although fewer studies on GTN were reported compared to studies on hydatidiform mole. The incidence of hydatidiform mole and GTN might be lower than estimated according to the following reasons.…”

Role of vitamins A, C, D, E in cancer prevention and therapy: therapeutic potentials and mechanisms of action

“…Another clinical trial demonstrated the effect of oral vitamin A (6,000 IU/day) in patients (n = 32) with low-risk gestational trophoblastic neoplasia who receive methotrexate chemotherapy ( 141 ). The intervention group exhibited a reduction of chemoresistance as well as a downregulation of the tumor marker β-hCG level ( 141 ).…”

“…Another clinical trial demonstrated the effect of oral vitamin A (6,000 IU/day) in patients (n = 32) with low-risk gestational trophoblastic neoplasia who receive methotrexate chemotherapy ( 141 ). The intervention group exhibited a reduction of chemoresistance as well as a downregulation of the tumor marker β-hCG level ( 141 ). It was reported in a randomized double-blind study that using vitamin A supplementation (8,000 IU/8 h) with neoadjuvant chemotherapy (64 weeks) in 15 patients (total sample size is 30) has significantly improved the therapeutic response in the treatment of an advanced cervical carcinoma ( 142 ).…”

Characteristics of Referral Patients with Gestational Trophoblastic Neoplasia in Dr. Hasan Sadikin General Hospital Bandung

“…Hydatidiform mole occurs in 1:51 to 1:141 pregnancies in Indonesia, and 1:28 to 1:105 pregnancies in West Java [3]. In Bandung, the incidence is 1:427 pregnancies, while GTN occurs in 1:822 pregnancies [4]. After evacuation, a complete mole exhibits a 15-20% likelihood of progressing to malignancy, while a partial hydatidiform A R T I C L E I N F O mole has a less than 5% risk of developing into GTN [5].…”