Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience

Maestá, Izildinha; Nitecki, Roni; Horowitz, Neil S.; Goldstein, Donald P.; Moreira, Marjory de Freitas Segalla; Elias, Kevin M.; Berkowitz, Ross S.

doi:10.1016/j.ygyno.2017.10.028

Cited by 62 publications

(48 citation statements)

References 39 publications

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“…This may be attributed to the reduction in the adverse reactions of CF, which minimizes autoimmune responses and improves patient prognosis. Compared to treatment with MTX alone, cotherapy with MTX and CF significantly decreased resistance rates and adverse reactions (Maestá et al 2017). Randomized controlled trials have shown that the efficacy and adverse effects of MTX-FA were significantly lower than those of ACT-D in treating patients with low-risk GTN (Shobeiri et al 2014), which is consistent with the results of this study.…”

Section: Discussionsupporting

confidence: 89%

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

Qiu

Zheng

2020

All Life

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Objective: This study aimed to compare the clinical efficacy and safety of a combination of methotrexate (MTX) plus calcium folinate (CF) and actinomycin D (ACT-D) treatment in patients with low-risk trophoblastic tumors. Methods: We included 95 and 101 patients who received chemotherapy with MTX plus CF (MTX + CF group) and ACT-D (ACT-D group). The cure rate, drug resistance rate, number of treatment courses, and adverse reactions were compared between both groups. Results : Age, International Federation of Gynecology and Obstetrics (FIGO) stage and score, prechemotherapy β-human chorionic gonadotropin (HCG) levels, and the nature of the last pregnancy were associated with the development of resistance. Furthermore, age, FIGO stage III, and a hydatidiform mole in the last pregnancy were independent risk factors for gestational trophoblastic neoplasia (GTN) after MTX + CF or ACT-D chemotherapy (P < 0.05). Both MTX + CF and ACT-D had a high cure rate and a low rate of resistance in gestational trophoblastic tumors. The adverse reaction incidence was lower in the MTX + CF group than in the ACT-D group. Conclusions: Advanced age, FIGO stage III, and a hydatidiform mole in the last pregnancy may be associated with the development of resistance to MTX + CF or ACT-D chemotherapy in patients with gestational trophoblastic tumors.

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Section: Discussionsupporting

confidence: 89%

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

Qiu

Zheng

2020

All Life

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“…In a group of 13 patients receiving intermittent high-dose methotrexate (30–250 mg/kg), there were reported symptoms of generalised pruritus, burning, irritation and blurred vision 9. Generalised eye symptoms such as conjunctivitis, dry eyes and blepharitis were also noted in patients who received methotrexate as part of their chemotherapy regimen for postmolar gestational trophoblastic neoplasia 10. There is also a case report of internuclear ophthalmoplegia in a 26-year-old man after receiving intrathecal methotrexate for lymphoma 11.…”

Section: Resultsmentioning

confidence: 99%

Ocular side effects of antirheumatic medications: a qualitative review

et al. 2020

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TopicThis paper reviews the ocular side effects of medications used in the treatment of rheumatological conditions.Clinical relevanceRheumatic diseases are inflammatory conditions that may affect the skin, blood vessels, joints, muscles and internal organs. Immunosuppressive agents are often used as treatment and while powerful, they carry side effects and toxicities that need careful monitoring. Ophthalmic complications have been reported with the use of antirheumatic medications; however, there is a lack of literature synthesising these reports. This paper addresses this gap and hopes to inform both rheumatologists and ophthalmologists as they work together on the management of patients with rheumatological conditions.MethodsPubMed literature search was conducted from November to September 2019 searching for ocular side effects with the use of 25 rheumatological drugs.ResultsA total of 111 papers were included in this review. Adverse side effects were divided into non-infectious and infectious causes. Traditional disease-modifying antirheumatic drugs (DMARDs) were associated with pruritus, irritation and dryness of the conjunctiva while biologic DMARDS showed reports of new-onset/recurrent uveitis and demyelinating conditions. Infectious side effects included episodes of cytomegalovirus retinitis, toxoplasmic chorioretinitis and endophthalmitis. Other serious side effects were encountered and included in this review.ConclusionThe goal of this paper is to inform healthcare providers about potential ocular side effects from rheumatological medications. Healthcare providers are encouraged to learn more about these ophthalmic complications and find relevance within their clinical practice.

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“…Although adverse events were more frequent in 8-day MTX-FA regimen, these events were self-limited and recovered without long-term sequelae. 27 In a study reported by Berkowitz et al 88% of patients with low-risk GTN achieved CR with 8-day MTX-FA regimen. The CR rate was 90.2% in stage 1 patients while it was 68% in patients with low-risk metastatic disease.…”

Section: Discussionmentioning

confidence: 96%

Retrospective Analysis of Gestational Trophoblastic Neoplasia: Single Center Experience

Sunar¹

2019

UHOD

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This study aims to analyze the clinicopathologic characteristics and treatment outcomes of our patients with gestational trophoblastic neoplasia (GTN) and to present our real-life experience. A total of 32 patients with GTN diagnosed according to the FIGO 2002 criteria followed in Zekai Tahir Burak Women's Health Training and Research Hospital between 2011-2018 were included. Demographic features, treatment outcomes, and survival were analyzed retrospectively. The median follow up time was 32.1 (3.3-76.9) months. Of the 32 patients, 27 (84.4%) were defined as low-risk GTN (risk score < 7) and 5 (15.6%) were high-risk GTN (risk score ≥ 7) according to the FIGO risk score. Seventeen (62.9%) patients with low-risk GTN achieved complete remission (CR) with single agent MTX. CR rate was 60% (12/20) in patients receiving weekly MTX and 71.4% (5/7) in MTX-FA eight-day regimen (p= 0.590). Of the 9 MTX resistant patients, 8 (88.8%) achieved CR with second-line Actinomycin D (ActD). Three (60%) out of the five high-risk GTN patients acquired CR with first-line EMA-CO (etoposide, MTX, plus ActD alternating with cyclophosphamide and vincristine). In the follow-up period one patient (3.1%) had recurrent disease. By the data cut off date, all of the patients were alive and CR could not be achieved in one (3.1%) patient. All patients with low-risk GTN achieved CR with sequential therapies ultimately. Therefore, single agent MTX is a reasonable option in the initial treatment of low-risk GTN. Moreover, Actinomycin D is highly effective in patients with low-risk GTN who are resistant to MTX.

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Effectiveness and toxicity of first-line methotrexate chemotherapy in low-risk postmolar gestational trophoblastic neoplasia: The New England Trophoblastic Disease Center experience

Cited by 62 publications

References 39 publications

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors

Ocular side effects of antirheumatic medications: a qualitative review

Retrospective Analysis of Gestational Trophoblastic Neoplasia: Single Center Experience

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