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Dobson, Leonard; Lorigan, Paul; Coleman, RE; Hancock, Barry W.

doi:10.1054/bjoc.2000.1176

Cited by 22 publications

(1 citation statement)

References 15 publications

(19 reference statements)

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“…Furthermore, 17 -36% of patients initially treated with low-risk MTX require a change of chemotherapy due to MTX resistance. To date, the most widely used marker for resistance to single-agent chemotherapy is a plateau or rise in serum hCG levels, which can obviously occur after several courses of treatment (Dobson et al, 2000;Garrett et al, 2002;McNeish et al, 2002;Matsui et al, 2005). Consequently, earlier detection of patients likely to develop resistance is desirable, so that more appropriate therapy can be given to cure the disease rapidly.…”

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External validation of serum hCG cutoff levels for prediction of resistance to single-agent chemotherapy in patients with persistent trophoblastic disease

et al. 2009

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Van Trommel et al have previously shown that serum human chorionic gonadotropin (hCG) cutoff levels can provide early prediction of resistance to first-line methotrexate (MTX) in patients with persistent trophoblastic disease (PTD). In this study, we validate this approach of prediction of resistance to single-agent chemotherapy in an independent and larger cohort of PTD patients using a different hCG assay. Receiver operating characteristics (ROC) curves were constructed to determine hCG cutoff levels and sensitivity between patients cured on single-agent chemotherapy (control group) and patients requiring change to combination chemotherapy (study group). Receiver operating characteristics analysis identified an hCG cutoff value of 737 IU l À1 that enabled us to predict the subsequent development of single-agent chemotherapy resistance in 52% of patients before their fourth MTX course at 97.5% specificity. This would have enabled an earlier switch to combination chemotherapy reducing the MTX exposure by an average of 2.5 courses. The present findings confirm that serum hCG cutoff levels predict resistance to single-agent therapy earlier than traditional methods. Change to combination chemotherapy should be considered for patients whose serum hCG levels exceed these hCG cutoff values. For patients not exceeding the hCG cutoff levels, static or rising hCG levels should still be included in the criteria for change of chemotherapy.

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External validation of serum hCG cutoff levels for prediction of resistance to single-agent chemotherapy in patients with persistent trophoblastic disease

et al. 2009

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Combination chemotherapy for primary treatment of high-risk gestational trophoblastic tumour

Deng

Zhang²,

et al. 2013

Cochrane Database of Systematic Reviews

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Phase II trial of pulse dactinomycin as salvage therapy for failed low‐risk gestational trophoblastic neoplasia

Covens

Filiaci

Burger

et al. 2006

Cancer

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BACKGROUND The purpose of the study was to determine the activity and toxicity of pulse dactinomycin as salvage treatment of patients with low‐risk gestational trophoblastic neoplasia (GTN) who failed methotrexate therapy. METHODS Eligible patients had persistent/recurrent low‐risk GTN defined by changes in serum human chorionic gonadotropin (hCG) levels (<10% fall over 3 consecutive weekly titers, >20% rise over the previous value, or a rise after attaining institutional normal [>5 mu/mL]); World Health Organization (WHO) score 2–6; Gynecologic Oncology Group (GOG) performance status 0–1; and previous treatment restricted to methotrexate. Dactinomycin administration was 1.25 mg/m2 intravenous (i.v.) every 2 weeks until documented complete response (CR) or treatment failure. CR was defined as an institutional normal serum hCG level sustained for ≥4 consecutive weeks; treatment failure was a <10% fall (3 assays over 4 weeks) or >20% rise (over previous value) in hCG serum level. Levels were monitored biweekly × 8 weeks beyond the first normal value, then monthly × 10. RESULTS Five of 44 enrolled patients were ineligible due to choriocarcinoma and normal pretreatment serum hCG level (2 each), no history of methotrexate (1), and 1 patient with documented phantom hCG syndrome was unevaluable. In all, 28 of 38 (74%) evaluable patients attained CR. The median number of cycles was 4 (range, 2–10). Severe toxicity was minimal, causing no patient to discontinue therapy. All treatment failures achieved a CR after receiving subsequent chemotherapy; 3 patients also underwent hysterectomy. CONCLUSION Pulse dactinomycin is an active regimen for patients withlow‐risk GTN who fail previous methotrexate therapy. Cancer 2006. © 2006 American Cancer Society.

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Cited by 22 publications

References 15 publications

External validation of serum hCG cutoff levels for prediction of resistance to single-agent chemotherapy in patients with persistent trophoblastic disease

External validation of serum hCG cutoff levels for prediction of resistance to single-agent chemotherapy in patients with persistent trophoblastic disease

Combination chemotherapy for primary treatment of high-risk gestational trophoblastic tumour

Phase II trial of pulse dactinomycin as salvage therapy for failed low‐risk gestational trophoblastic neoplasia

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