The management and outcome of women with post-hydatidiform mole ‘low-risk’ gestational trophoblastic neoplasia, but hCG levels in excess of 100 000 IU l−1

Abstract

Background: Gestational trophoblastic neoplasia (GTN) after a hydatidiform mole is either treated with single- or multi-agent chemotherapy determined by a multifactorial scoring system. Women with human chorionic gonadotrophin (hCG) levels >100 000 IU l −1 can remain within the low-risk/single-agent category and usually choose one drug therapy. Here we compare the success and duration of single- vs multi-agent chemotherapy in this patient group. Methods: Between 1980 and 2008, 65 women had a pre-treatment hCG >100 000 IU l −1 and were low risk. The initial hCG level, treatment regimens, changes and duration and overall survival were recorded. Results: Of 37 patients starting low-risk/single-agent treatment, 11 (29.7%) were treated successfully, whereas 26 (70.3%) required additional multi-agent chemotherapy to achieve complete remission (CR). Combination chemotherapy was initially commenced in 28 women, and 2 (7%) required additional drugs for CR. The overall duration of therapy for those commencing and completing single- or multi-agent chemotherapy was 130 and 123 days ( P =0.78), respectively. The median-treatment duration for patients commencing single-agent but changing to multi-agent chemotherapy was 13 days more than those receiving high-risk treatment alone (136 vs 123 days; P =0.07). All 3 patients with an initial hCG >400 000 IU l −1 and treated with single-agent therapy developed drug resistance. Overall survival for all patients was 100%. Conclusion: Low-risk post-molar GTN patients with a pre-treatment hCG >100 000 and <400 000 IU l −1 can be offered low-risk single-agent therapy, as this will cure 30%, is relatively non-toxic and only prolongs treatment by 2 weeks if a change to combination agents is required. Patients whose hCG is >400 000 IU l −1 should receive multi-agent chemotherapy from the outset.

Gestational Trophoblastic Neoplasia: Experience from a Tertiary Care Center of India

“…This protocol could be a good option in low-risk patients especially in developing countries. Our treatment outcomes are comparable with national and international data in low-risk disease [9][10][11][12].…”

“…The average number of chemotherapy cycles received for normalization of serum b-hCG levels was 4.82 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12).In high-risk group, patients received on average 5.1 cycles (3-8), while in low-risk group, patients received on average 4.46 cycles (2-12) for normalization of serum b-hCG levels.…”

“…The total number of chemotherapy cycles received on average was 7.08 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In high-risk patients, average number of cycles received was 7.6 (4-11), while in lowrisk patients, it was 6.13 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…In high-risk patients, average number of cycles received was 7.6 (4-11), while in lowrisk patients, it was 6.13 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Update on the diagnosis and management of gestational trophoblastic disease

“…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.…”