A 30-year experience in using oral methotrexate as initial treatment for gestational trophoblastic neoplasia regardless of risk group

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A 30-year experience in using oral methotrexate as initial treatment for gestational trophoblastic neoplasia regardless of risk group. / Faaborg, Louise; Niemann, Isa; Ostenfeld, Eva Bjerre; Hansen, Estrid S; Sunde, Lone; Lindegaard, Jacob C.

In: Acta Oncologica, Vol. 55, No. 2, 2016, p. 234-239.

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@article{7aeb8a0aa6c34eb6a0628c7d654dd0fb,
title = "A 30-year experience in using oral methotrexate as initial treatment for gestational trophoblastic neoplasia regardless of risk group",
abstract = "BACKGROUND: Treatment of postmolar gestational trophoblastic neoplasia (GTN) is often stratified according to FIGO score using methotrexate (MTX) for low-risk patients and first-line multi-agent chemotherapy (e.g. EMA-CO) for high-risk patients. In contrast, oral MTX may be given as first-line therapy to all GTN patients regardless of risk group. The aim was to examine the efficacy of oral MTX and a response-adapted treatment policy, which has been used for three decades at Aarhus University Hospital (AUH).MATERIAL AND METHODS: Seventy-one consecutive postmolar GTN patients treated 1981-2011 were included. Data were obtained from medical records, using histopathology and human choriogonadotropin (hCG) to verify the diagnosis. All patients received oral MTX as first-line chemotherapy. Second- and third-line chemotherapy was given according to response.RESULTS: Sixty-four (90{\%}) patients were retrospectively categorized as FIGO low-risk disease, whereas seven patients (10{\%}) had high-risk disease. Complete response to first-line oral MTX chemotherapy was observed in 35/71 (49{\%}) patients, while 62/71 (87{\%}) had complete remission on MTX (first-line) and/or MTX plus dactinomycin (second-line), without the use of multi-agent therapy. Nine patients (13{\%}) received third-line multi-agent chemotherapy, six low-risk (67{\%}) and three high-risk (33{\%}) patients. There were no recurrences and no patients died as a consequence of toxicity or disease.CONCLUSION: Fifty percent of all patients can be cured on oral MTX alone. By adding dactinomycin, about 90{\%} are cured without use of multi-agent chemotherapy. The use of oral MTX as initial treatment can minimize the number of patients receiving multi-agent chemotherapy.",
author = "Louise Faaborg and Isa Niemann and Ostenfeld, {Eva Bjerre} and Hansen, {Estrid S} and Lone Sunde and Lindegaard, {Jacob C}",
year = "2016",
doi = "10.3109/0284186X.2015.1059486",
language = "English",
volume = "55",
pages = "234--239",
journal = "Acta Oncologica",
issn = "0284-186X",
publisher = "Taylor & francis",
number = "2",

}

RIS

TY - JOUR

T1 - A 30-year experience in using oral methotrexate as initial treatment for gestational trophoblastic neoplasia regardless of risk group

AU - Faaborg, Louise

AU - Niemann, Isa

AU - Ostenfeld, Eva Bjerre

AU - Hansen, Estrid S

AU - Sunde, Lone

AU - Lindegaard, Jacob C

PY - 2016

Y1 - 2016

N2 - BACKGROUND: Treatment of postmolar gestational trophoblastic neoplasia (GTN) is often stratified according to FIGO score using methotrexate (MTX) for low-risk patients and first-line multi-agent chemotherapy (e.g. EMA-CO) for high-risk patients. In contrast, oral MTX may be given as first-line therapy to all GTN patients regardless of risk group. The aim was to examine the efficacy of oral MTX and a response-adapted treatment policy, which has been used for three decades at Aarhus University Hospital (AUH).MATERIAL AND METHODS: Seventy-one consecutive postmolar GTN patients treated 1981-2011 were included. Data were obtained from medical records, using histopathology and human choriogonadotropin (hCG) to verify the diagnosis. All patients received oral MTX as first-line chemotherapy. Second- and third-line chemotherapy was given according to response.RESULTS: Sixty-four (90%) patients were retrospectively categorized as FIGO low-risk disease, whereas seven patients (10%) had high-risk disease. Complete response to first-line oral MTX chemotherapy was observed in 35/71 (49%) patients, while 62/71 (87%) had complete remission on MTX (first-line) and/or MTX plus dactinomycin (second-line), without the use of multi-agent therapy. Nine patients (13%) received third-line multi-agent chemotherapy, six low-risk (67%) and three high-risk (33%) patients. There were no recurrences and no patients died as a consequence of toxicity or disease.CONCLUSION: Fifty percent of all patients can be cured on oral MTX alone. By adding dactinomycin, about 90% are cured without use of multi-agent chemotherapy. The use of oral MTX as initial treatment can minimize the number of patients receiving multi-agent chemotherapy.

AB - BACKGROUND: Treatment of postmolar gestational trophoblastic neoplasia (GTN) is often stratified according to FIGO score using methotrexate (MTX) for low-risk patients and first-line multi-agent chemotherapy (e.g. EMA-CO) for high-risk patients. In contrast, oral MTX may be given as first-line therapy to all GTN patients regardless of risk group. The aim was to examine the efficacy of oral MTX and a response-adapted treatment policy, which has been used for three decades at Aarhus University Hospital (AUH).MATERIAL AND METHODS: Seventy-one consecutive postmolar GTN patients treated 1981-2011 were included. Data were obtained from medical records, using histopathology and human choriogonadotropin (hCG) to verify the diagnosis. All patients received oral MTX as first-line chemotherapy. Second- and third-line chemotherapy was given according to response.RESULTS: Sixty-four (90%) patients were retrospectively categorized as FIGO low-risk disease, whereas seven patients (10%) had high-risk disease. Complete response to first-line oral MTX chemotherapy was observed in 35/71 (49%) patients, while 62/71 (87%) had complete remission on MTX (first-line) and/or MTX plus dactinomycin (second-line), without the use of multi-agent therapy. Nine patients (13%) received third-line multi-agent chemotherapy, six low-risk (67%) and three high-risk (33%) patients. There were no recurrences and no patients died as a consequence of toxicity or disease.CONCLUSION: Fifty percent of all patients can be cured on oral MTX alone. By adding dactinomycin, about 90% are cured without use of multi-agent chemotherapy. The use of oral MTX as initial treatment can minimize the number of patients receiving multi-agent chemotherapy.

U2 - 10.3109/0284186X.2015.1059486

DO - 10.3109/0284186X.2015.1059486

M3 - Journal article

VL - 55

SP - 234

EP - 239

JO - Acta Oncologica

JF - Acta Oncologica

SN - 0284-186X

IS - 2

ER -