Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience

Autor(es)

Maesta, Izildinha ^{[1, 2, 3]} ; Nitecki, Roni ^[4] ; Horowitz, Neil S. ^{[5, 6, 7, 8]} ; Goldstein, Donald P. ^{[5, 6, 7, 8]} ; Segalla Moreira, Marjory de Freitas ^{[1, 2, 3]} ; Elias, Kevin M. ^{[5, 6, 7, 8]} ; Berkowitz, Ross S. ^{[5, 6, 7, 8]}

Afiliação do(s) autor(es)

^[1] Sao Paulo State Univ, UNESP, Botucatu Med Sch, Dept Gynecol & Obstet, Botucatu, SP - Brazil

^[2] Sao Paulo State Univ, UNESP, Botucatu Med Sch, Trophoblast Dis Ctr, Botucatu, SP - Brazil

^[3] Sao Paulo State Univ, UNESP, Botucatu Med Sch, Postgrad Program Gynecol Obstet & Mastol, Botucatu, SP - Brazil

^[4] Brigham & Womens Hosp, Dept Obstet & Gynecol, 75 Francis St, Boston, MA 02115 - USA

^[5] Harvard Med Sch, Boston, MA - USA

^[6] Brigham & Womens Hosp, Dept Obstet & Gynecol, Div Gynecol Oncol, 75 Francis St, Boston, MA 02115 - USA

^[7] New England Trophoblast Dis Ctr, Donald P Goldstein MD Tumor Registry, Boston, MA - USA

^[8] Harvard Canc Ctr, Dana Farber Canc Inst, Boston, MA - USA

• Tipo de documento: Artigo Científico
• Fonte: GYNECOLOGIC ONCOLOGY; v. 148, n. 1, p. 161-167, JAN 2018.
• Citações Web of Science: 8

Resumo

Objectives. To assess the outcomes and toxicity of first-line methotrexate (MTX) chemotherapy in low-risk postmolar gestational trophoblastic neoplasia (GTN) patients receiving 8-day methotrexate or one-day methotrexate infusion regimens. Methods. This retrospective cohort study was conducted at the New England Trophoblastic Disease Center (NETDC), between 1974 and 2014, and included 325 patients with FIGO-defined low-risk postmolar GTN receiving first-line 8-day MTX/folinic acid (FA) or one-day MTX infusion and FA. Demographics, disease presentation, initial treatment plan, treatment outcome, and treatment-related adverse events were assessed. Results. Sustained remission (84% vs 62%, p < 0.001) and need to switch to second-line therapy due to treatment-related adverse events (53% vs 0%, p = 0.001) were higher for 8-day MTX/FA compared to one-day MIX infusion. MTX resistance, however, was more frequent with one-day MTX (34.5%) than with 8-day MTX/ FA (7.3%, p < 0.001). Relapse rates were similar with both regimens (3.0%). Compared to one-day MTX infusion, 8-day MTX/FA was associated with significantly higher gastrointestinal disorders (48% vs 24%), abnormal laboratory findings (48% vs 28%), eye disorders (37% vs 19%) and general disorders (22% vs 5%) (p < 0.001). Only infection frequency did not differ between 8-day MTX/FA and one-day MTX infusion (20% vs 12%, p = 0.083). Conclusions. This is one of the largest studies to comprehensively catalogue toxicities associated with 8-day MTX/FA and one-day MTX infusion. Although treatment-related adverse events were more frequent with 8 day MTX/FA, these were all self-limited and resolved with no long-term sequelae. Given this and its higher effectiveness, 8-day MTX/FA remains the treatment of choice at NETDC for patients with low-risk postmolar GTN. (C) 2017 Published by Elsevier Inc. (AU)

• Processo FAPESP: 15/12530-0 - Eficácia e toxicidade de dois diferentes esquemas de tratamento com metotrexate/ácido folínico em pacientes com neoplasia trofoblástica pós-molar de baixo risco
• Beneficiário: Izildinha Maestá
• Modalidade de apoio: Bolsas no Exterior - Pesquisa