Response to chemotherapy in overweight/obese patients with low-risk gestational trophoblastic neoplasia
Izildinha Maestá1, Neil S Horowitz, Donald P Goldstein
1*Department of Gynecology and Obstetrics, and †Trophoblastic Diseases Center, Botucatu Medical School, UNESP-Sao Pãulo State University, Botucatu, Sao Pãulo, Brazil; ‡Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital; §New England Trophoblastic Disease Center, Donald P. Goldstein M.D. Tumor Registry; ∥Dana Farber Cancer Institute/Harvard Cancer Center; and ¶Harvard Medical School, Boston, MA; #Clinical Department, Caldas University, Manizales, Caldas, Colombia; and **Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA.
Objective:
Despite rising global obesity rates, the impact of obesity on gestational trophoblastic neoplasia (GTN) remains uninvestigated. This study aimed at investigating whether overweight/obesity relates to response to chemotherapy in low-risk GTN patients.
Methods:
This nonconcurrent cohort study included 300 patients with International Federation of Gynecology and Obstetrics-defined postmolar low-risk GTN treated with a single-agent chemotherapy—methotrexate or actinomycin-D (actD)—between 1973 and 2012 at the New England Trophoblastic Disease Center. Chemotherapy dosing was based on actual body weight regardless of obesity status, except for 5-day courses or pulse regimens of actD. Patients were classified as overweight/obese (body mass index [BMI] ≥25 kg/m²) or non-overweight/obese (BMI <25 kg/m²). Information on patient characteristics and response to chemotherapy (need for second-line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles, need for combination chemotherapy, and time to human chorionic gonadotropin remission) was obtained.
Results:
Of 300 low-risk GTN patients, 81 (27%) were overweight/obese. Overweight/obese patients were older than the non-overweight/obese patients (median age: 30 vs 28 years, P = 0.004). First-line therapy using actD was more frequent in overweight/obese patients (6.2% vs 1.4%, P = 0.036). Resistance and toxicity were similar between groups. No significant difference in the number of chemotherapy cycles needed for remission or time required to achieve remission was found between groups.
Conclusions:
No association between overweight/obesity and low-risk GTN outcomes was found. Current chemotherapy dosing using BMI seems to be appropriate for overweight/obese patients with low-risk GTN.
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