Prophylactic Chemotherapy with Methotrexate Leucovorin in High-Risk Hydatidiform Mole

Abstract

Aim: Gestational Trophoblastic Neoplasia (GTN) is used to describe a group of malignant gestational tumors originating from the placenta. The chance of having malignant GTN is high in a high-risk molar pregnancy. The main aim of this study is to investigate the effectiveness of using prophylactic chemotherapy in high-risk molar pregnancy to prevent malignant GTN. Method: In this case-control retrospective study, all patients with high-risk mole referred to Firoozgar and Akbarabadi Hospitals affiliated with Iran University of Medical Sciences (IUMS) from 2003 to 2013 were divided into two groups of recipient and non-recipient of methotrexate prophylactic chemotherapy.Demographic information including age, parity, weight, serum βHCG before and after the intervention, level of liver function tests (LFT) and GTN were analyzed. Results: There were 102 patients with a mean age of 27.13 years (SD= 0.37), and 51 patients (50 %) received prophylactic Methotrexate (MTX), and others were the non-receivers. Finally, 23 patients (22.5%) were inflicted with GTN, and 79 (77.5 %) did not. The average time of βHCG spontaneous remission between the groups were 2.5 (SD=1.33) and 3.2 (SD=1.21), for the recipient and non-recipient, respectively, which showed a significant difference (p). Conclusion: This study concludes that prophylactic chemotherapy with MTX and leucovorin may be capable of reducing GTN, which supports the prescription of MTX in high-risk mole, especially in countries with limited resources. The toxicity of methotrexate can be reduced with the addition of leucovorin.

Effect of single-dose methotrexate injection to prevent neoplastic changes in high risk complete hydatidiform mole: A randomised control trial

“…Mean age of participants in this study was about five years lower than two other studies conducted at Tehran and Ankara. [ 9 13 ] The Ankara study had 39% primigravid women, which is quite close to the present study. Pre evacuation β HCG level had wider dispersion in the Ankara study (minimum 551 mIU/ml- maximum 844,441 mIU/ml) compared to present study (22,918 to 360,000 mIU/ml) which can be attributed to the enrolment of both high-risk and low-risk CHM.…”

“…Reported time for spontaneous remission of β HCG was 3.2 ± 1.21 months and it was 2.5 ± 1.33 for women with high-risk CHM treated with methotrexate-leucovorin prophylactic CT.[ 9 ] Post evacuation β HCG values and NT as prognostic markers has been explored in several studies. A meta-analysis reports only 0.3% incidence of post-molar GTN following β HCG normalization in CHM.…”

“…[ 11 ] Anticipated means were extracted from a similar study comparing prophylactic (CT) and spontaneous normalization of β HCG in months, with α = 0.05 and β = 60%. [ 9 ] The calculated sample size was 35 in each arm. The recruitment and follow-up of participants have been shown in [ Figure 1 ], CONSORT flow diagram.…”

“…[ 8 ] However, prophylactic chemotherapy with methotrexate and leucovorin rescue is associated with earlier normalization time (NT). [ 9 ] Single-dose methotrexate without leucovorin rescue is an established treatment for low-risk GTN. With this regimen, significant side effect is not reported.…”

The role of single-dose prophylactic methotrexate in the prevention of post-molar gestational trophoblastic neoplasia in patients with high-risk molar pregnancy

“…Yamamoto et al [3] investigated 472 patients with high-risk CHM and found that gestational week, serum βHCG level at one week after the rst evacuation, and pathological remnants were signi cantly associated with the development of PGTN. Aminimoghaddam et al [20] divided 102 patients with high-risk CHM into two groups: recipients and non-recipients of MTX (Methotrexate 1mg/kg in the odd days (1,3,5,7) and leucovorin 0.1 mg/kg (IM) in the even days (2,4,6,8)). In the MTX recipient group, 13.7% of cases developed PGTN, while in the non-recipient group, 31.4% of cases developed PGTN (p-value: 0.03).…”