Autor(es):
Maestá, Izildinha [UNESP] ; Nitecki, Roni ; Desmarais, Cecilia Canedo Freitas [UNESP] ; Horowitz, Neil S. ; Goldstein, Donald P. ; Elias, Kevin M. ; Berkowitz, Ross S.
Data: 2020
Identificador Persistente: http://hdl.handle.net/11449/200030
Origem: Oasisbr
Assunto(s): Actinomycin D; Effectiveness; Low-risk gestational trophoblastic neoplasia; Second-line chemotherapy; Toxicity; Actinomycin D; Actinomycin D; Effectiveness; Effectiveness; Low-risk gestational trophoblastic neoplasia; Low-risk gestational trophoblastic neoplasia; Second-line chemotherapy; Second-line chemotherapy; Toxicity; Toxicity
Descrição
Made available in DSpace on 2020-12-12T01:55:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-05-01
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Objectives: The purpose of this study was to evaluate both the outcomes and toxicity of second-line actinomycin D (ActD) chemotherapy in methotrexate (MTX) - resistant low-risk postmolar gestational trophoblastic neoplasia (GTN) with 5-day ActD versus pulsed ActD. Methods: This retrospective cohort study included patients with MTX-resistant low-risk postmolar GTN from 1974 to 2016. Second-line chemotherapy consisted of 5-day ActD (10–12 μg/kg per day for 5 days every 14 days) or biweekly ActD (1.25 mg/m2 every 2 weeks). Data on patient characteristics, disease presentation, treatment outcome, and toxicity were collected. Results: Sixty-eight MTX-resistant patients receiving ActD as second-line chemotherapy were identified (5-day ActD, 53 patients; pulsed ActD, 15 patients). No significant differences were observed in patient/disease characteristics and sustained remission (overall rate 72%) between second-line ActD regimens. Time to hCG remission was significantly faster (median 21 vs 47 days, p = .04) and required fewer treatment cycles (median 1 vs 2, p < .001) with 5-day ActD. Thrombocytopenia was only observed with 5-day ActD (64.6 vs 0%, p < .001). The frequency (60.4 vs 16.7%, p = .009) and severity (grade 3: 37.9 vs 0%, p = .045) of oral mucositis was significantly higher with 5-day ActD. Grade 2 alopecia was significantly more frequent (70.6 vs 16.7%, p = .02) with 5-day ActD. Conclusions: While 5-day ActD and pulsed ActD achieve comparable remission rates, due to its reduced toxicity, ease of administration, and patient convenience, pulsed ActD should be the treatment of choice for MTX-resistant postmolar low-risk GTN.
Botucatu Trophoblastic Disease Center Botucatu Medical School Hospital Department of Gynecology and Obstetrics UNESP—Sao Paulo State University
Postgraduate Program in Tocogynecology of Botucatu Medical School UNESP—São Paulo State University
Department of Obstetrics and Gynecology Brigham and Women's Hospital
New England Trophoblastic Disease Center Division of Gynecologic Oncology Department of Obstetrics Gynecology and Reproductive Biology Brigham and Women's Hospital
Harvard Medical School
Botucatu Trophoblastic Disease Center Botucatu Medical School Hospital Department of Gynecology and Obstetrics UNESP—Sao Paulo State University
Postgraduate Program in Tocogynecology of Botucatu Medical School UNESP—São Paulo State University
