Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia
Main Author: | |
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Publication Date: | 2020 |
Other Authors: | , , , , , |
Format: | Article |
Language: | eng |
Source: | Repositório Institucional da UNESP |
Download full: | http://dx.doi.org/10.1016/j.ygyno.2020.02.001 http://hdl.handle.net/11449/200030 |
Summary: | 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. |
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Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasiaActinomycin DEffectivenessLow-risk gestational trophoblastic neoplasiaSecond-line chemotherapyToxicityObjectives: 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.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Botucatu Trophoblastic Disease Center Botucatu Medical School Hospital Department of Gynecology and Obstetrics UNESP—Sao Paulo State UniversityPostgraduate Program in Tocogynecology of Botucatu Medical School UNESP—São Paulo State UniversityDepartment of Obstetrics and Gynecology Brigham and Women's HospitalNew England Trophoblastic Disease Center Division of Gynecologic Oncology Department of Obstetrics Gynecology and Reproductive Biology Brigham and Women's HospitalHarvard Medical SchoolBotucatu Trophoblastic Disease Center Botucatu Medical School Hospital Department of Gynecology and Obstetrics UNESP—Sao Paulo State UniversityPostgraduate Program in Tocogynecology of Botucatu Medical School UNESP—São Paulo State UniversityUniversidade Estadual Paulista (Unesp)Brigham and Women's HospitalHarvard Medical SchoolMaestá, Izildinha [UNESP]Nitecki, RoniDesmarais, Cecilia Canedo Freitas [UNESP]Horowitz, Neil S.Goldstein, Donald P.Elias, Kevin M.Berkowitz, Ross S.2020-12-12T01:55:45Z2020-12-12T01:55:45Z2020-05-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article372-378http://dx.doi.org/10.1016/j.ygyno.2020.02.001Gynecologic Oncology, v. 157, n. 2, p. 372-378, 2020.1095-68590090-8258http://hdl.handle.net/11449/20003010.1016/j.ygyno.2020.02.0012-s2.0-85078960105Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengGynecologic Oncologyinfo:eu-repo/semantics/openAccess2024-08-16T14:12:51Zoai:repositorio.unesp.br:11449/200030Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-16T14:12:51Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia |
title |
Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia |
spellingShingle |
Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia Maestá, Izildinha [UNESP] Actinomycin D Effectiveness Low-risk gestational trophoblastic neoplasia Second-line chemotherapy Toxicity |
title_short |
Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia |
title_full |
Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia |
title_fullStr |
Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia |
title_full_unstemmed |
Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia |
title_sort |
Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia |
author |
Maestá, Izildinha [UNESP] |
author_facet |
Maestá, Izildinha [UNESP] Nitecki, Roni Desmarais, Cecilia Canedo Freitas [UNESP] Horowitz, Neil S. Goldstein, Donald P. Elias, Kevin M. Berkowitz, Ross S. |
author_role |
author |
author2 |
Nitecki, Roni Desmarais, Cecilia Canedo Freitas [UNESP] Horowitz, Neil S. Goldstein, Donald P. 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 Harvard Medical School |
dc.contributor.author.fl_str_mv |
Maestá, Izildinha [UNESP] Nitecki, Roni Desmarais, Cecilia Canedo Freitas [UNESP] Horowitz, Neil S. Goldstein, Donald P. Elias, Kevin M. Berkowitz, Ross S. |
dc.subject.por.fl_str_mv |
Actinomycin D Effectiveness Low-risk gestational trophoblastic neoplasia Second-line chemotherapy Toxicity |
topic |
Actinomycin D Effectiveness Low-risk gestational trophoblastic neoplasia Second-line chemotherapy Toxicity |
description |
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. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-12-12T01:55:45Z 2020-12-12T01:55:45Z 2020-05-01 |
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.2020.02.001 Gynecologic Oncology, v. 157, n. 2, p. 372-378, 2020. 1095-6859 0090-8258 http://hdl.handle.net/11449/200030 10.1016/j.ygyno.2020.02.001 2-s2.0-85078960105 |
url |
http://dx.doi.org/10.1016/j.ygyno.2020.02.001 http://hdl.handle.net/11449/200030 |
identifier_str_mv |
Gynecologic Oncology, v. 157, n. 2, p. 372-378, 2020. 1095-6859 0090-8258 10.1016/j.ygyno.2020.02.001 2-s2.0-85078960105 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Gynecologic Oncology |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
372-378 |
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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1808128197105025024 |