Chemotherapy initiation with single-course methotrexate alone or combined with dactinomycin versus multi-course methotrexate for low-risk gestational trophoblastic neoplasia: a multi-centric randomized clinical trial

Chen, Lili; Liu, Xi; Jiang, Jie; Yin, Rong; Qu, Pengpeng; Li, Xiuqin; Wan, Xiaoxia; Chen, Yaxia; Hu, Dong; Mao, Yuliang; Zhang, Pan; Cheng, Xiaodong; Wang, Xinyu; Li, Qingli; Weng, Danhui; Zhang, Xi; Zhang, Hong; Ping, Quanhong; Liu, Xiaomei; Xie, Xing; Kong, Beihua; Ma, Ding; Lü, Weiguo

doi:10.1007/s11684-021-0855-4

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…Patients with a FIGO score ≤ 6 are categorized as low risk and typically undergo primarily first-line single-agent methotrexate (MTX) chemotherapy [1]. Am J Cancer Res 2024;14(3):1353-1362 Despite the widespread use of the FIGO 2000 scoring system, the initial remission rates of GTN patients receiving MTX treatment range from 53% to 87% [2][3][4]. The primary remission rate for patients with FIGO scores of 0-4 is between 50%-85%, whereas for those with scores of 5-6, it falls within the 12%-52% [4,5].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for methotrexate resistance in low-risk gestational trophoblastic neoplasia patients (FIGO score 0-4)

Jin

2024

Am J Cancer Res

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The challenge of methotrexate (MTX) resistance among low-risk gestational trophoblastic neoplasia (GTN) patients has always been prominent. Despite the International Federation of Gynaecology and Obstetrics (FIGO) score of 0-4 patients comprising the majority of low-risk GTN patients, a comprehensive exploration of the prevalence and risk factors associated with MTX resistance has been limited. Therefore, we aimed to identify associated risk factors in GTN patients with a FIGO score of 0-4. Between January 2005 and December 2020, 310 low-risk GTN patients received primary MTX chemotherapy in two hospitals, with 265 having a FIGO score of 0-4. In the FIGO 0-4 subgroup, 94 (35.5%) were resistant to MTX chemotherapy, and 34 (12.8%) needed multi-agent chemotherapy. Clinicopathologic diagnosis of postmolar choriocarcinoma (OR = 17.18, 95% CI: 4.64-63.70, P < 0.001) and higher pretreatment human chorionic gonadotropin concentration on a logarithmic scale (log-hCG concentration) (OR = 18.11, 95% CI: 3.72-88.15, P < 0.001) were identified as independent risk factors associated with MTX resistance according to multivariable logistic regression. The decision tree model and regression model were developed to predict the risk of MTX resistance in GTN patients with a FIGO score of 0-4. Evaluation of model discrimination, calibration and net benefit revealed the superiority of the decision tree model, which comprised clinicopathologic diagnosis and pretreatment hCG concentration. The patients in the high-and medium-risk groups of the decision tree model had a higher probability of MTX resistance. This study represents the investigation into MTX resistance in GTN patients with a FIGO score of 0-4 and disclosed a remission rate of approximately 65% with MTX chemotherapy. Higher pretreatment hCG concentration and clinicopathologic diagnosis of postmolar choriocarcinoma were independent risk factors associated with resistance to MTX chemotherapy. The decision tree model demonstrated enhanced predictive capabilities regarding the risk of MTX resistance and can serve as a valuable tool to guide the clinical treatment decisions for GTN patients with a FIGO score of 0-4.

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Section: Introductionmentioning

confidence: 99%

Risk factors for methotrexate resistance in low-risk gestational trophoblastic neoplasia patients (FIGO score 0-4)

Jin

2024

Am J Cancer Res

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Effectiveness and Efficiency Comparison of One-Day vs Eight-Day Methotrexate Protocols in Managing Low-Risk Gestational Trophoblastic Neoplasia

Agbari,

Hidayat,

Kurniadi

et al. 2024

IJWH

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Background Gestational Trophoblastic Neoplasia (GTN) has a high incidence in Bandung, Indonesia, with a mortality rate between 31% and 51%. The most common type is low-risk GTN with various treatment protocols available. The 8-day Methotrexate (MTX) 50 mg protocol has been implemented at our center; however, due to limitation of government insurance, this study aims to compare its effectiveness against the 1-day Methotrexate (MTX) 300 mg/m² protocol. Methods A retrospective cohort study compared two protocols for low-risk GTN treatment at Dr. Hasan Sadikin General Hospital from January 2020 to December 2023: a 1-day Methotrexate (MTX) 300 mg/m² protocol and an 8-day MTX protocol (50 mg MTX IM on days 1, 3, 5, 7 with folinic acid 15 mg orally 24 h after MTX on days 2, 4, 6, 8) and repeat every 2 weeks. Data on patient characteristics, chemotherapy response, side effects, and treatment costs were analyzed. Results The 1-day MTX 300 mg/m² protocol achieved similar remission with fewer cycles, milder side effects, and reduced costs compared to the 8-day MTX 50 mg protocol, supporting it as an effective treatment option for low-risk GTN. Conclusion The 1-day MTX 300 mg/m² protocol is as an effective treatment option for low-risk GTN compared to the 8-day MTX 50 mg protocol.

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Chemotherapy initiation with single-course methotrexate alone or combined with dactinomycin versus multi-course methotrexate for low-risk gestational trophoblastic neoplasia: a multi-centric randomized clinical trial

Cited by 2 publications

References 15 publications

Risk factors for methotrexate resistance in low-risk gestational trophoblastic neoplasia patients (FIGO score 0-4)

Risk factors for methotrexate resistance in low-risk gestational trophoblastic neoplasia patients (FIGO score 0-4)

Effectiveness and Efficiency Comparison of One-Day vs Eight-Day Methotrexate Protocols in Managing Low-Risk Gestational Trophoblastic Neoplasia

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