Treatment results of the second-line chemotherapy regimen for patients with low-risk gestational trophoblastic neoplasia treated with 5-day methotrexate and 5-day etoposide

Kanno, Toshiyuki; Akizawa, Yoshika; Usui, Hirokazu; Shozu, Makio

doi:10.3802/jgo.2018.29.e89

Cited by 7 publications

(7 citation statements)

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“…No significant differences in cure and drug resistance rates were observed between the MTX + CF and ACT-D groups, which is inconsistent with the findings of previous studies (Osborne et al 2015;Kanno et al 2018). This may be attributed to the reduction in the adverse reactions of CF, which minimizes autoimmune responses and improves patient prognosis.…”

Section: Discussioncontrasting

confidence: 86%

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

Qiu

Zheng

2020

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Objective: This study aimed to compare the clinical efficacy and safety of a combination of methotrexate (MTX) plus calcium folinate (CF) and actinomycin D (ACT-D) treatment in patients with low-risk trophoblastic tumors. Methods: We included 95 and 101 patients who received chemotherapy with MTX plus CF (MTX + CF group) and ACT-D (ACT-D group). The cure rate, drug resistance rate, number of treatment courses, and adverse reactions were compared between both groups. Results : Age, International Federation of Gynecology and Obstetrics (FIGO) stage and score, prechemotherapy β-human chorionic gonadotropin (HCG) levels, and the nature of the last pregnancy were associated with the development of resistance. Furthermore, age, FIGO stage III, and a hydatidiform mole in the last pregnancy were independent risk factors for gestational trophoblastic neoplasia (GTN) after MTX + CF or ACT-D chemotherapy (P < 0.05). Both MTX + CF and ACT-D had a high cure rate and a low rate of resistance in gestational trophoblastic tumors. The adverse reaction incidence was lower in the MTX + CF group than in the ACT-D group. Conclusions: Advanced age, FIGO stage III, and a hydatidiform mole in the last pregnancy may be associated with the development of resistance to MTX + CF or ACT-D chemotherapy in patients with gestational trophoblastic tumors.

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Section: Discussioncontrasting

confidence: 86%

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

Qiu

Zheng

2020

All Life

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“…The success of this combination therapy is due to the two drugs' complementary actions. Kanno et al (2018) reported the same result, that single MTX administration to low risk GTN patients resulted in remission failure (35 %). To overcome this condition, a second line of therapy is required; one of the combinations used is MTX and ETP for 5 days, and complete remission is achieved by 83.3 percent of the total patients who experience therapy failure using single chemotherapy.…”

Section: Discussionmentioning

confidence: 65%

“…After a single chemotherapy administration of MTX, or etoposide (ETP), the low-risk GTN achieves nearly 100 percent complete remission patients [17]. Methotrexate can effectively inhibit trophoblast cell proliferation by inhibiting DNA replication and the cell cycle in the S phase [18].…”

Section: Discussionmentioning

confidence: 99%

“…However, approximately 20% until 30% of GTN patients receiving chemotherapy must alter their regimens because of drug resistance, severe side effect and relapse [17], [19] . Age, FIGO stage and score, prechemotherapy -hCG level, and the nature of the previous pregnancy were all found to be associated with drug resistance in univariate analysis [19].…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Methotrexate and Etoposide as Adjuvant Therapy on Patient with Hydatidiform Moles that Have Growing Rapidly Becomes Gestational Trophoblastic Neoplasia

Supriyono

2022

EJMED

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A hydatidiform mole is a type of placental abnormality that is associated with gestational trophoblastic disease (GTD). It can be complete or partial mole. They are typically considered benign, but they are also premalignant, with the potential to become malignant and invasive to other organs (gestational trophoblastic neoplasia/GTN). Management of the hydatiform moles is curettage therapy and suction, which aims to therapy and diagnostic. Follow-up post evacuation of moles must be tight with serum hCG and clinical examination. When there is evidence of vaginal bleeding and an increase in serum hCG, chemotherapy must be used as an adjuvant. This case report intends to persuade clinicians that adjuvant therapy with chemotherapy combination-based Methotrexate/MTX and etoposide can recover and eliminate vaginal bleeding disorders. On her first pregnancy, a woman of 27 years old develops a complete hydatiform mole. The curettage and suction procedure were then performed twice. She also receives chemotherapy in three series of single MTX and three series of MTX plus Etoposide. Following this therapy, the patient recovers, normal hCG level and has no vaginal bleeding problems.

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“…Both defining and treating low-risk GTN remain somewhat controversial [4]. Tumor resistance is described as an increase in hCG levels or their stagnation over a 2 to 3-week period [5], although there is no internationally accepted consensus on the definition of drug resistance resulting from chemotherapy [6]. There is also no diagnostic tool available to predict chemoresistance and consequently to establish an appropriate treatment schema at the beginning of therapy.…”

Section: Discussionmentioning

confidence: 99%

The value of an initial drop in human Chorionic gonadotropin levels in predicting a response to methotrexate in women with low-risk gestational trophoblastic neoplasia

et al. 2019

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Objectives:The early identification of patients who are being treated for low-risk gestational trophoblastic neoplasia (LRGTN) with single-agent chemotherapy, who are at high risk of developing chemoresistance, is of crucial importance. The aim of our research was to evaluate the pretreatment beta subunit of human chorionic gonadotropin (βhCG) concentration and its decrease after the administration of the first course of methotrexate (MTX) in predicting later chemo-resistance to single-agent chemotherapy. Material and methods:A total of 46 patients diagnosed with LRGTN treated with a 5-day methotrexate (MTX) regimen were retrospectively studied. 24 of the patients were successfully cured with only MTX therapy (MTX group). The disease was considered resistant in the remaining 22 patients who, after MTX therapy, required further chemotherapy with an EMA/CO regimen (EMA/CO group). To compare changes in the βhCG concentrations between the two courses of treatment (and the two groups), we calculated the percentage of decline. We determined the specificity and sensitivity of the initial βhCG level and its percentage decline, as a potential predictor of the need for a future EMA/CO regimen. For diagnostic purposes, βhCG levels were measured before the first and second administrations of MTX with a commercial ELISA kit. Results:In the EMA/CO group, we found the initial βhCG level before the first MTX dose was higher (median = 6275 mIU/mL, range: 21. 53-192.610.0 mIU/mL) than in the MTX group (median = 532 mIU/mL, range: 56.5 mIU/mL-360.397.0 mIU/mL) (p = 0.034, Mann-Whitney test). The percentage decreases in the βhCG values relative to the initial concentrations were higher in the MTX group (median decrease = 82.7%, range: from 13.3% to 99.9%) than in the EMA/CO group (median decrease = 71.1%, range: from an increase of 56.1% to a decrease of 97.1%) (p = 0.0079, Mann-Whitney test). An analysis of the ROC curves implied optimal cutoff values for the initial βHCG (6054 IU, sensitivity = 55%, specificity = 86%) and the percentage change in βhCG levels (decrease by 76.5%, sensitivity = 72%, specificity = 71%). Conclusions:1. Women with initially higher βhCG levels have a greater risk of developing MTX chemo resistance. 2. It would be advantageous to consider administering an EMA/CO regimen in women with LRGTN when their initial βhCG levels are greater than 6000.

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Treatment results of the second-line chemotherapy regimen for patients with low-risk gestational trophoblastic neoplasia treated with 5-day methotrexate and 5-day etoposide

Cited by 7 publications

References 16 publications

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

Case Report: Methotrexate and Etoposide as Adjuvant Therapy on Patient with Hydatidiform Moles that Have Growing Rapidly Becomes Gestational Trophoblastic Neoplasia

The value of an initial drop in human Chorionic gonadotropin levels in predicting a response to methotrexate in women with low-risk gestational trophoblastic neoplasia

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