First-line chemotherapy in low-risk gestational trophoblastic neoplasia

ArticleinCochrane database of systematic reviews (Online) 7(7):CD007102 · July 2012with44 Reads
DOI: 10.1002/14651858.CD007102.pub3 · Source: PubMed
Abstract
Gestational trophoblastic neoplasia (GTN) is a rare but curable disease. Patients are categorised into low or high risk groups using a variety of scoring systems. The majority of patients with low risk GTN respond to chemotherapy, however, occasionaly patients will die. A large number of regimens are used worldwide in the management of low risk GTN. The choice of the regimen is usually dependent on geographic location, prior training and current experience with the specific regimen. Regimens have significant differences in route of administration, hospitalisation and side effects and so have a bearing on healthcare cost. This review examined the studies, both randomised and non-randomised, that compared the available regimens. We found that bi-weekly "pulsed" dactinomycin was superior to weekly methotrexate in the reported doses. We believe further high quality randomised controlled trials are required to establish the best first line chemotherapy regimen for low risk GTN as the currently used chemotherapy regimens are based on the experience of the treating centres.
    • " Treatment of GTN is generally by chemotherapy. The best regimen to use depends on stage and classification. In the 2000 FIGO staging and classification (Tables 1 and 2), a risk score of 6 and below is classified as low risk and above 6 is considered high risk. [26]. Methotrexate was associated with significantly more treatment failure than actinomycin D (RR 3.81; 95% CI, 1.64−8.86). A further trial is ongoing, comparing not only efficacy, but toxicity and quality of life of pulsed actinomycin D and multiday methotrexate regimens [27]. Chemotherapy should be changed to the alternative single agent "
    Full-text · Article · Oct 2015
    • "All three trials showed better primary Complete Response (CR) rates without the need for additional salvage therapy associated with pulsed dactinomycin (relative risk [RR] of cure, 3.00; 95% Confidence Interval [CI], 1.10–8.17), even though the magnitude of benefit showed substantial heterogeneity (I2 statistic = 79%) [36][37][38]. Fewer courses of therapy were needed to achieve CR and cure with dactinomycin treatment. As expected, salvage chemotherapy was nearly uniformly successful, because almost all low-risk GTN patients are ultimately cured, irrespective of the initial chemotherapeutic regimen. "
    Article · Jan 2015 · Current Oncology Reports
    • "However, the relatively low efficacy of repeated D&C and small risks of introducing infection, haemorrhage or uterine perforation should be balanced against a nearly 100 % cure rate with chemotherapy [1]. Several treatment regimens have been developed for lowrisk GTN, of which the most frequently used are methotrexate/ folinic acid and actinomycin D. A few randomized trials have compared methotrexate-based regimens with actinomycin D, suggesting that the latter is more likely to induce remission, but these studies were underpowered and compared regimens that are not commonly used internationally [28] . A larger international randomized controlled trial to address the question of the optimal first-line treatment is currently open and is comparing the more frequently used methotrexate regimens methotrexate/ folinic acid (Table 3)and methotrexate at 0.4 mg/kg (maximum 25 mg) administered intravenously on days 1–5 every 2 weeks in one arm with actinomycin D at 1.25 mg/m 2 administered intravenously every 2 weeks in the other arm [29]. "
    [Show abstract] [Hide abstract] ABSTRACT: Gestational trophoblastic disease describes a variety of pregnancy-related diseases including the premalignant conditions of a partial and complete hydatidiform mole and the malignant disorders of invasive mole, choriocarcinoma and the rare placental-site trophoblastic tumour and epithelioid trophoblastic tumour. The availability of a highly sensitive tumour marker in the form of human chorionic gonadotrophin, the chemosensitive character of the disease with effective treatment strategies and centralization of care of a rare group of diseases has resulted in excellent survival rates, which can exceed 98 %. This review gives a general overview of gestational trophoblastic disease, the most recent insights in aetiology and pathology and a summary of the different management strategies.
    Full-text · Article · Nov 2014
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