J Gynecol Oncol.  2018 Nov;29(6):e89. 10.3802/jgo.2018.29.e89.

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 T
• Matsui H
• Akizawa Y
• Usui H
• Shozu M

• KMID: 2431234
• DOI: http://doi.org/10.3802/jgo.2018.29.e89

Abstract

OBJECTIVE
Highly effective chemotherapy for patients with low-risk gestational trophoblastic neoplasia (GTN) is associated with almost a 100% cure rate. However, 20%-30% of patients treated with chemotherapy need to change their regimens due to severe adverse events (SAEs) or drug resistance. We examined the treatment outcomes of second-line chemotherapy for patients with low-risk GTN.
METHODS
Between 1980 and 2015, 281 patients with low-risk GTN were treated. Of these 281 patients, 178 patients were primarily treated with 5-day intramuscular methotrexate (MTX; n=114) or 5-day drip infusion etoposide (ETP; n=64). We examined the remission rates, the drug change rates, and the outcomes of second-line chemotherapy.
RESULTS
The primary remission rates and drug resistant rates of 5-day ETP were significantly higher (p < 0.001) and significantly lower (p=0.002) than those of 5-day MTX, respectively. Forty-seven patients (26.4%) required a change in their chemotherapy regimen due to the SAEs (n=16) and drug resistance (n=31), respectively. Of these 47 patients failed the first-line regimen, 39 patients (39/47, 82.9%) were re-treated with single-agent chemotherapy, and 35 patients (35/39, 89.7%) achieved remission. Four patients failed second-line, single-agent chemotherapy and eight patients (17.0%) who failed first-line regimens were treated with combined or multi-agent chemotherapy and achieved remission.
CONCLUSIONS
Patients with low-risk GTN were usually treated with single-agent chemotherapy, while 20%-30% patients had to change their chemotherapy regimen due to SAEs or drug resistance. The second-line regimens of single-agent chemotherapy were effective; however, there were several patients who needed multiple agents and combined chemotherapy to achieve remission.

Keyword

Low-risk Gestational Trophoblastic Neoplasm; Drug Resistance; Chemotherapy

MeSH Terms

Drug Resistance
Drug Therapy*
Etoposide*
Gestational Trophoblastic Disease*
Humans
Infusions, Intravenous
Methotrexate*
Etoposide
Methotrexate