Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1016/j.ygyno.2017.10.028 http://hdl.handle.net/11449/175412 |
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 (5.3% vs 0%, p = 0.001) were higher for 8-day MTX/FA compared to one-day MTX 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. |
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Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experienceEffectivenessFirst-line methotrexate chemotherapyLow-risk gestational trophoblastic neoplasiaToxicityObjectives 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 (5.3% vs 0%, p = 0.001) were higher for 8-day MTX/FA compared to one-day MTX 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.Department of Gynecology and Obstetrics Botucatu Medical School UNESP-Sao Paulo State UniversityDepartment of Obstetrics and Gynecology Brigham and Women's Hospital BostonDepartment of Obstetrics and Gynecology Division of Gynecologic Oncology Brigham and Women's HospitalNew England Trophoblastic Disease Center Donald P. Goldstein M.D. Tumor RegistryTrophoblastic Diseases Center of the Botucatu Medical School UNESP-Sao Paulo State UniversityPostgraduate Program of Gynecology Obstetrics and Mastology of Botucatu Medical School UNESP-São Paulo State UniversityDana Farber Cancer Institute/Harvard Cancer CenterHarvard Medical SchoolDepartment of Gynecology and Obstetrics Botucatu Medical School UNESP-Sao Paulo State UniversityTrophoblastic Diseases Center of the Botucatu Medical School UNESP-Sao Paulo State UniversityPostgraduate Program of Gynecology Obstetrics and Mastology of Botucatu Medical School UNESP-São Paulo State UniversityUniversidade Estadual Paulista (Unesp)Brigham and Women's Hospital BostonBrigham and Women's HospitalDonald P. Goldstein M.D. Tumor RegistryDana Farber Cancer Institute/Harvard Cancer CenterHarvard Medical SchoolMaestá, Izildinha [UNESP]Nitecki, RoniHorowitz, Neil S.Goldstein, Donald P.de Freitas Segalla Moreira, Marjory [UNESP]Elias, Kevin M.Berkowitz, Ross S.2018-12-11T17:15:43Z2018-12-11T17:15:43Z2018-01-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article161-167application/pdfhttp://dx.doi.org/10.1016/j.ygyno.2017.10.028Gynecologic Oncology, v. 148, n. 1, p. 161-167, 2018.1095-68590090-8258http://hdl.handle.net/11449/17541210.1016/j.ygyno.2017.10.0282-s2.0-850325684822-s2.0-85032568482.pdfScopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengGynecologic Oncology2,3392,339info:eu-repo/semantics/openAccess2023-10-21T06:07:23Zoai:repositorio.unesp.br:11449/175412Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-10-21T06:07:23Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience |
title |
Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience |
spellingShingle |
Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience Maestá, Izildinha [UNESP] Effectiveness First-line methotrexate chemotherapy Low-risk gestational trophoblastic neoplasia Toxicity |
title_short |
Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience |
title_full |
Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience |
title_fullStr |
Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience |
title_full_unstemmed |
Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience |
title_sort |
Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience |
author |
Maestá, Izildinha [UNESP] |
author_facet |
Maestá, Izildinha [UNESP] Nitecki, Roni Horowitz, Neil S. Goldstein, Donald P. de Freitas Segalla Moreira, Marjory [UNESP] Elias, Kevin M. Berkowitz, Ross S. |
author_role |
author |
author2 |
Nitecki, Roni Horowitz, Neil S. Goldstein, Donald P. de Freitas Segalla Moreira, Marjory [UNESP] Elias, Kevin M. Berkowitz, Ross S. |
author2_role |
author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) Brigham and Women's Hospital Boston Brigham and Women's Hospital Donald P. Goldstein M.D. Tumor Registry Dana Farber Cancer Institute/Harvard Cancer Center Harvard Medical School |
dc.contributor.author.fl_str_mv |
Maestá, Izildinha [UNESP] Nitecki, Roni Horowitz, Neil S. Goldstein, Donald P. de Freitas Segalla Moreira, Marjory [UNESP] Elias, Kevin M. Berkowitz, Ross S. |
dc.subject.por.fl_str_mv |
Effectiveness First-line methotrexate chemotherapy Low-risk gestational trophoblastic neoplasia Toxicity |
topic |
Effectiveness First-line methotrexate chemotherapy Low-risk gestational trophoblastic neoplasia Toxicity |
description |
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 (5.3% vs 0%, p = 0.001) were higher for 8-day MTX/FA compared to one-day MTX 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. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-12-11T17:15:43Z 2018-12-11T17:15:43Z 2018-01-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1016/j.ygyno.2017.10.028 Gynecologic Oncology, v. 148, n. 1, p. 161-167, 2018. 1095-6859 0090-8258 http://hdl.handle.net/11449/175412 10.1016/j.ygyno.2017.10.028 2-s2.0-85032568482 2-s2.0-85032568482.pdf |
url |
http://dx.doi.org/10.1016/j.ygyno.2017.10.028 http://hdl.handle.net/11449/175412 |
identifier_str_mv |
Gynecologic Oncology, v. 148, n. 1, p. 161-167, 2018. 1095-6859 0090-8258 10.1016/j.ygyno.2017.10.028 2-s2.0-85032568482 2-s2.0-85032568482.pdf |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Gynecologic Oncology 2,339 2,339 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
161-167 application/pdf |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
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1799964643629727744 |