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The 16-year experience in treating low-risk gestational trophoblastic neoplasia patients with failed primary

Xiaodong Wu1, Jiale Qin2,3, Tao Shen1

  • 1Department of Gynecologic Oncology, Women's Hospital, School of Medicine Zhejiang University, Hangzhou, China.

Journal of Gynecologic Oncology
|February 7, 2020
PubMed
Abstract

Insights

Actinomycin D (Act-D) is effective salvage therapy for low-risk gestational trophoblastic neoplasia (GTN) after methotrexate (MTX) failure. Higher hCG levels before Act-D may predict resistance, but toxicity is generally well-tolerated.

Area of Science:

  • Gynecology
  • Oncology
  • Pharmacology

Background:

  • Low-risk gestational trophoblastic neoplasia (GTN) can be challenging to treat.
  • Methotrexate (MTX) chemotherapy is a primary treatment for low-risk GTN.
  • Some patients with low-risk GTN fail to respond to initial MTX chemotherapy.

Purpose of the Study:

  • To evaluate the efficacy and toxicity of 5-day actinomycin D (Act-D) as salvage therapy for low-risk GTN.
  • To identify predictors of resistance to Act-D in patients with low-risk GTN who previously failed MTX therapy.

Main Methods:

  • Retrospective analysis of 89 patients with low-risk GTN treated with Act-D salvage therapy after MTX failure.
  • Data collected included clinical parameters and treatment outcomes.
  • Serum human chorionic gonadotrophin (hCG) levels before Act-D salvage therapy were analyzed.

Main Results:

  • Act-D salvage therapy achieved an 82.02% response rate in 89 patients.
  • Act-D resistant cases (16/89) achieved remission with alternative chemotherapy regimens.
  • Higher pre-Act-D hCG levels were associated with Act-D resistance (p=0.009).
  • Act-D toxicity was generally well-tolerated, with a 100% survival rate and no recurrence at 1-year follow-up.

Conclusions:

  • Actinomycin D (Act-D) salvage therapy is recommended for low-risk GTN patients who fail methotrexate (MTX) chemotherapy due to its good efficacy and tolerable toxicity.
  • Elevated serum hCG levels prior to Act-D treatment may indicate a higher risk of resistance to this salvage regimen.
Keywords:
Actinomycin DGestational Trophoblastic NeoplasiaMethotrexateSalvage Therapy

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