The outcome of patients with low risk gestational trophoblastic neoplasia treated with single agent intramuscular methotrexate and oral folinic acid

Taylor, Fiona; Grew, T.; Everard, J; Ellis, Laura; Winter, M.C.; Tidy, John; Hancock, B. W.; Coleman, Robert E.

doi:10.1016/j.ejca.2013.06.004

Cited by 37 publications

(34 citation statements)

References 27 publications

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“…Even though a diagnosis of choriocarcinoma may be a poor prognostic factor and predict for drug resistance, there is the argument that as overall survival is 100% for patients with low risk GTN [11,13,20,21] the least toxic regimen should be administered first [4]. Patients that develop resistance are identified early due to an increase or plateau of hCG levels.…”

Section: Discussionmentioning

confidence: 97%

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A retrospective study to evaluate single agent methotrexate treatment in low risk gestational choriocarcinoma in the United Kingdom

Taylor

Short

Winter

et al. 2015

Gynecologic Oncology

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Section: Discussionmentioning

confidence: 97%

“…There have been calls to revise the FIGO prognostic scoring system to take into account high rates of resistance in low risk GTN patients with hCG N 100,000 iu/L or hCG N 400,000 iu/L or FIGO total score of 6 [21][22][23]. Should a diagnosis of choriocarcinoma be considered an adverse prognostic factor independent of the FIGO scoring system?…”

Section: Discussionmentioning

confidence: 97%

A retrospective study to evaluate single agent methotrexate treatment in low risk gestational choriocarcinoma in the United Kingdom

Taylor

Short

Winter

et al. 2015

Gynecologic Oncology

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“…A recent study found that resistance to first line ChT may develop when the FIGO/WHO score is six or when hCG is higher than 100,000 IU/L. Based on those findings, the authors suggested a change in the cut-off point for low-risk disease from six to five, or the assignment of a score of six, and not of four, to patients with hCG higher than 100,000 IU/L before treatment 35 . Evidence suggests that patients with hCG above 400,000 IU/L should begin ChT with multiple agents because of the significantly greater resistance to singleagent ChT 34 .…”

Section: Low-risk Diseasementioning

confidence: 99%

Diagnosis, classification and treatment of gestational trophoblastic neoplasia

Biscaro¹,

Braga²,

Berkowitz³

2015

Rev. Bras. Ginecol. Obstet.

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Gestational trophoblastic neoplasia (GTN) is the term to describe a set of malignant placental diseases, including invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Both invasive mole and choriocarcinoma respond well to chemotherapy, and cure rates are greater than 90%. Since the advent of chemotherapy, low-risk GTN has been treated with a single agent, usually methotrexate or actinomycin D. Cases of high-risk GTN, however, should be treated with multiagent chemotherapy, and the regimen usually selected is EMA-CO, which combines etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine. This study reviews the literature about GTN to discuss current knowledge about its diagnosis and treatment. ResumoNeoplasia trofoblástica gestacional (NTG) é o termo que descreve o conjunto de anomalias malignas da placenta, incluindo a mola invasora, coriocarcinoma, tumor trofoblástico do sítio placentário e tumor trofoblástico epitelióide. Ambos a mola invasora e o coriocarcinoma respondem bem à quimioterapia, com taxas de cura superiores a 90%. Desde o advento da quimioterapia, NTG de baixo risco tem sido tratada com monoquimioterapia, pelo geral methotrexate ou actinomicina-D. Casos de NTG de alto risco, contudo, devem ser tratados com poliquimioterapia, e o regime usualmente escolhido é o EMA-CO que combina etoposide, methotrexate, actinomicina-D, ciclofosfamida e vincristina. Esse estudo revê a literatura sobre NTG a fim de discutir os conhecimentos atuais sobre seu diagnóstico e tratamento.

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“…Osborne et al 16 have suggested that pulsed Act-D is more likely to induce remission than weekly MTX but this randomized study has been underpowered. We are waiting for the results of an larger international trial run by the Gynecology Oncology Group in the United States, begun in 2013 (NCT01535053), evaluating quality of life and acceptability of treatment with the objective of helping to define the optimum single-agent approach 17,23 . However, this trial did not include the chosen MTX regimen as we used in this study.…”

Section: Discussionmentioning

confidence: 99%

Treatment of low-risk gestational trophoblastic neoplasia comparing biweekly eight-day Methotrexate with folinic acid versus bolus-dose Actinomycin-D, among Brazilian women

Uberti¹,

Fajardo²,

Cunha³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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-D), biweekly. At GTN diagnosis, patient opinion was taken into consideration when defining the initial single-agent ChT regimen, and when there was resistance or toxicity to one regimen, the other drug was used preferentially. This study was approved by the Irmandade da Santa Casa de Misericórdia de Porto Alegre Ethical Committee. RESULTS: Both groups were clinically similar (p>0.05). In first-line treatments, frequency of complete response was similar (75.7% with MTX/FA and 67.1% with bolus Act-D); the number of ChT courses -median 3 (range: 1-10) with MTX/FA and 2 (range: 1-6) with bolus Act-D -and the time to remission -median 9 weeks (range: 2-16) with MTX/FA and 10 weeks (range: 2-16) with bolus Act-D) -were not different between the groups. In both groups, first-line side effects frequency were high but intensity was low; stomatitis was higher with MTX/FA (p<0.01) and nausea and vomit with Act-D (p<0.01).Final single-agent ChT responses were high in both groups (94.8% with MTX/FA and 83.5% with bolus Act-D; p<0.01) and 13% higher in the group initially treated with MTX/FA. Rates of hysterectomy and of GTN recurrence were low and similar. No patient died due to GTN. CONCLUSION: The two regimens had similar first-line ChT response. Final single-agent response rates were high and similar in both groups but the final single-agent remission rate was higher in the MTX/FA group. Treatment of low-risk gestational trophoblastic neoplasia comparing biweekly eight-day Methotrexate with folinic acid versus bolus-dose Actinomycin-D, among Brazilian women

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The outcome of patients with low risk gestational trophoblastic neoplasia treated with single agent intramuscular methotrexate and oral folinic acid

Cited by 37 publications

References 27 publications

A retrospective study to evaluate single agent methotrexate treatment in low risk gestational choriocarcinoma in the United Kingdom

A retrospective study to evaluate single agent methotrexate treatment in low risk gestational choriocarcinoma in the United Kingdom

Diagnosis, classification and treatment of gestational trophoblastic neoplasia

Treatment of low-risk gestational trophoblastic neoplasia comparing biweekly eight-day Methotrexate with folinic acid versus bolus-dose Actinomycin-D, among Brazilian women

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