Journal of Gynecologic Oncology

  • 제29권6호
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  • Pages.89.1-89.8
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  • 2018
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  • 2005-0380(pISSN)
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  • 2005-0399(eISSN)
대한부인종양학회 (Korean Society of Gynecologic Oncology)
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Treatment results of the second-line chemotherapy regimen for patients with low-risk gestational trophoblastic neoplasia treated with 5-day methotrexate and 5-day etoposide

  • Kanno, Toshiyuki (Department of Obstetrics and Gynecology, Tokyo Women's Medical University) ;
  • Matsui, Hideo (Department of Obstetrics and Gynecology, Tokyo Women's Medical University) ;
  • Akizawa, Yoshika (Department of Obstetrics and Gynecology, Tokyo Women's Medical University) ;
  • Usui, Hirokazu (Department of Reproductive Medicine, Chiba University Graduate School of Medicine) ;
  • Shozu, Makio (Department of Reproductive Medicine, Chiba University Graduate School of Medicine)
  • 투고 : 2018.05.08
  • 심사 : 2018.07.18
  • 발행 : 2018.11.10
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: Highly effective chemotherapy for patients with low-risk gestational trophoblastic neoplasia (GTN) is associated with almost a 100% cure rate. However, 20%-30% of patients treated with chemotherapy need to change their regimens due to severe adverse events (SAEs) or drug resistance. We examined the treatment outcomes of second-line chemotherapy for patients with low-risk GTN. Methods: Between 1980 and 2015, 281 patients with low-risk GTN were treated. Of these 281 patients, 178 patients were primarily treated with 5-day intramuscular methotrexate (MTX; n=114) or 5-day drip infusion etoposide (ETP; n=64). We examined the remission rates, the drug change rates, and the outcomes of second-line chemotherapy. Results: The primary remission rates and drug resistant rates of 5-day ETP were significantly higher (p<0.001) and significantly lower (p=0.002) than those of 5-day MTX, respectively. Forty-seven patients (26.4%) required a change in their chemotherapy regimen due to the SAEs (n=16) and drug resistance (n=31), respectively. Of these 47 patients failed the first-line regimen, 39 patients (39/47, 82.9%) were re-treated with single-agent chemotherapy, and 35 patients (35/39, 89.7%) achieved remission. Four patients failed second-line, single-agent chemotherapy and eight patients (17.0%) who failed first-line regimens were treated with combined or multi-agent chemotherapy and achieved remission. Conclusions: Patients with low-risk GTN were usually treated with single-agent chemotherapy, while 20%-30% patients had to change their chemotherapy regimen due to SAEs or drug resistance. The second-line regimens of single-agent chemotherapy were effective; however, there were several patients who needed multiple agents and combined chemotherapy to achieve remission.

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참고문헌

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피인용 문헌

  1. Etoposide/methotrexate : Drug resistance leading to treatment failure, drug eruptions and increased aminotransferase levels: 5 case reports vol.1741, pp.1, 2019, https://doi.org/10.1007/s40278-019-58349-z
  2. Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors vol.13, pp.1, 2018, https://doi.org/10.1080/26895293.2020.1830186
  3. Effectiveness and toxicity of second-line actinomycin D in patients with methotrexate-resistant postmolar low-risk gestational trophoblastic neoplasia vol.157, pp.2, 2018, https://doi.org/10.1016/j.ygyno.2020.02.001