Chemo-resistant gestational trophoblastic neoplasia, 5-years experience of Mansoura University Hospital, Egypt

Abstract

Introduction: Gestational trophoblastic neoplasia (GTN), is recognized as the most curable gynaecologic malignancy. However, many cases are resistant to first line chemotherapy. Objective: The aim of the study is to report our 5 years experience in the management of GTN cases with special stress on the chemo-resistant cases. Methods: The study was performed through reviewing the records of 51 patients who were diagnosed as GTN during the period from 1/1/2006 to 31/12/2010 in Mansoura University Hospital, Egypt. Results: Resistance to methotrexate therapy was reported in 15.15% of low risk cases and received etoposide or cisplatinum/etoposide. Sixty percent of high risk cases were resistant to MAC combination and received salvage chemotherapy or hysterectomy. There was significant correlation between patient response and initial B-hCG, as well as WHO risk score (P value = 0.001 in both) but correlations with age, parity, type of antecedent pregnancy, and histopathology were non significant (p = 0.95, 0.53, 0.47& 0.83 respectively). Conclusion: Low risk GTN cases who were resistant to methotrexate monotherapy received etoposide or cisplatinum/etoposide as a second-line therapy. High risk GTN cases who were resistant to MAC combination received second-line combination chemotherapy and/or hysterectomy. WHO risk score and initial B-hCG were correlated to resistance to first line chemotherapy

Resistance to single‐agent chemotherapy and its risk factors in low‐risk gestational trophoblastic neoplasms

“…Similar to our findings, several studies reported that the score and metastasis, β‐hCG level, mass size and distance from index pregnancy were the main prognostic factors . As expected, the most important factor was the disease score.…”

“…Similar to our findings, several studies reported that the score and metastasis, β-hCG level, mass size and distance from index pregnancy were the main prognostic factors. 2,3,[18][19][20][21][22] As expected, the most important factor was the disease score. In our study, patients with a score of 5 and 6, which is commonly known as the intermediate risk group, had a 14-fold higher risk of resistance to single-agent chemotherapy, compared with the low-risk group (score, ≤4).…”

“…For instance, a very high remission rate to a single agent has been reported from the USA (92%) and Hungary (96%) . A primary remission rate of more than 70% was reported from the USA, France, Korea and Egypt . Most studies had a 100% remission rate after combination therapy for the resistant patients.…”

“…16 A primary remission rate of more than 70% was reported from the USA, 3 France, 2 Korea 17 and Egypt. 18 Most studies had a 100% remission rate after combination therapy for the resistant patients.…”

Chemo-resistant gestational trophoblastic neoplasia: a review of cases at a tertiary cancer centre

“…This is also seen in majority of the studies. 4,5 Metastases were present in 33.64% of cases and the most common site was lungs (72.22%).…”