Low-Risk Persistent Gestational Trophoblastic Disease: Outcome After Initial Treatment With Low-Dose Methotrexate and Folinic Acid From 1992 to 2000

McNeish, Iain A.; Strickland, Sarah; Holden, L.; Rustin, G. J. S.; Foskett, Marianne; Seckl, Michael J.; Newlands, E. S.

doi:10.1200/jco.2002.07.166

Cited by 223 publications

(195 citation statements)

References 19 publications

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“…Initial reports on 487 patients from Charing Cross (Bagshawe et al, 1989) and 115 from Sheffield (Dorreen et al, 1988) confirmed its efficacy, although it was noted that up to 30% of patients needed second-line treatment due to resistance or, less frequently, toxicity. In the recent Charing Cross report of use of this regimen for low-/intermediate-risk patients, 33.2% of 485 patients required a change in treatment; however, overall survival was 100% (McNeish et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…There are several different protocols for treatment administration, but larger comparative studies of their efficacy and toxicity, as well as long-term outcome are needed. However, the UK experience with low-dose intramuscular methotrexate is extensive (Dorreen et al, 1988;Bagshawe et al, 1989;McNeish et al, 2002) and this is a relatively inexpensive and cost beneficial treatment (Hancock, 1997). Our study confirms the efficacy and relative lack of severe short-and long-term toxicity of this regimen.…”

Section: Discussionmentioning

confidence: 99%

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Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

et al. 2003

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The aim of this study was to evaluate the efficacy and toxicity of low-dose methotrexate with folinic acid rescue in a large series of consecutively treated patients with low-risk persistent gestational trophoblastic disease. Between January 1987 and December 2000, 250 patients were treated with intramuscular methotrexate (50 mg on alternate days 1, 3, 5, 7) with folinic acid (7.5 mg orally on alternate days 2, 4, 6, 8) rescue. The overall complete response rate without recurrence was 72% for first-line treatment and 95% for those who required second-line chemotherapy. Eight women (3.2%) had recurrence following remission and two (0.8%) had new moles. Two women (0.8%) died of their disease giving an overall cure of 99%. Only 10 women (4%) experienced grade III/IV toxicity during the first course of treatment and 13 women (5.2%) subsequently. Toxicity included mucositis and stomatitis, pleuritic chest pain, thrombocytopenia, uterine bleeding, abdominal pain, liver function changes, rash and pericardial effusion. A total of 59 women (23.6%) required second-line chemotherapy; 48 women had methotrexate resistance, eight had methotrexate toxicity and an empirical decision to change therapy was made in three. In all, 11 women (4.4%) had a hysterectomy before, during or after treatment; 141 women (56.4%) became pregnant following treatment: in 128 (90.7%), the outcome was successful. Methotrexate with folinic acid rescue is an effective treatment for low-risk persistent trophoblastic disease. It has minimal severe toxicity, excellent cure rates and does not appear to affect fertility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

et al. 2003

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“…Clinical, biochemical and radiological details (either computer tomography (CT) or chest X-ray (CXR), or both) at presentation and on completion of chemotherapy were recorded. At presentation for chemotherapy, patients were staged according to nationally and internationally accepted criteria for GTN, stratified into low-or high-risk groups, and treated accordingly (Bagshawe, 1976;Kohorn, 2001;McNeish et al, 2002). Individuals with low-risk disease were treated with subcutaneous methotrexate and folinic acid, whereas those with high-risk disease were given weekly combination chemotherapy, comprising of etoposide, methotrexate, and actinomycin alternating with cyclophospohmide and vincristine (EMA/CO).…”

Section: Methodsmentioning

confidence: 99%

Residual lung lesions after completion of chemotherapy for gestational trophoblastic neoplasia: should we operate?

et al. 2005

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The significance of residual lung metastasis from malignant gestational trophoblastic neoplasm (GTN) after the completion of chemotherapy is unknown. We currently do not advocate resection of these masses. Here, we investigate the outcome of these patients. Patients with residual lung abnormalities after the completion of treatment for GTN were compared to those who had a complete radiological resolution of the disease. None of the residual masses post-treatment were surgically removed. In all, 76 patients were identified. Overall 53 (70%) patients had no radiological abnormality on CXR or CT after completion of treatment. Eight (11%) patients had residual disease on CXR alone 15 patients had residual disease on CT (19%). During follow-up, two patients (2.6%) relapsed. One of these had had a complete radiological response post-treatment whereas the other had residual disease on CT. Patients with residual lung lesions after completing treatment for GTN do not appear to have an increased chance of relapse compared to those with no residual abnormality. We continue to recommend that these patients do not require pulmonary surgery for these lesions.

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“…If there is an inadequate response to the initial single agent, a significant elevation in hCG level, development of metastasis, or resistance to sequential single-agent chemotherapy, multi-agent chemotherapy as for high-risk disease should be initiated [2]. Studies in the UK showed that if the hCG level is less than 100 IU/L or 300 IU/L, change to single-agent Act-D gives a good response [2,28,29]; otherwise, multiple agents need to be used.…”

Section: Low-risk Gestational Trophoblastic Neoplasiamentioning

confidence: 99%

Update on the diagnosis and management of gestational trophoblastic disease

Ngan

Seckl

Berkowitz

et al. 2015

Intl J Gynecology & Obste

251

403

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Low-Risk Persistent Gestational Trophoblastic Disease: Outcome After Initial Treatment With Low-Dose Methotrexate and Folinic Acid From 1992 to 2000

Abstract: Single-agent dactinomycin has activity in patients with low-risk GTD who develop MTX resistance and whose hCG is low. Simplifying the stratification of GTD into two classes (low- and high-risk) does not compromise overall outcome and may reduce the risk of second tumors.

Cited by 223 publications

References 19 publications

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

Low-risk persistent gestational trophoblastic disease treated with low-dose methotrexate: efficacy, acute and long-term effects

Residual lung lesions after completion of chemotherapy for gestational trophoblastic neoplasia: should we operate?

Update on the diagnosis and management of gestational trophoblastic disease

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