Outcomes of women diagnosed and treated for low‐risk gestational trophoblastic neoplasia at the Queensland Trophoblast Centre (QTC)

Verhoef, Lisanne; Baartz, David; Morrison, Shona; Sanday, Karen; Garrett, Andrea

doi:10.1111/ajo.12622

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…After full-text screening, we ultimately included 17 studies that met the eligibility criteria in the present analysis: 8 RCTs [6,[19][20][21][22][23][24][25] and 9 non-RCTs [26][27][28][29][30][31][32][33][34]. The flow diagram in Fig.…”

Section: Studies Selection and Characteristicsmentioning

confidence: 99%

Direct comparisons of efficacy and safety between actinomycin-D and methotrexate in women with low-risk gestational trophoblastic neoplasia: a meta-analysis of randomized and high-quality non-randomized studies

et al. 2021

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Background Actinomycin-D (Act-D) and Methotrexate (MTX) are both effective first-line agents for low-risk gestational trophoblastic neoplasia (LRGTN) with no consensus regarding which is more effective or less toxic. The primary objective of this meta-analysis is to compare Act-D with MTX in the treatment of LRGTN. Methods We systematically searched electronic databases, conferences abstracts and trial registries for randomized controlled trials (RCTs) and high-quality non-randamized controlled trials (non-RCTs), comparing Act-D with MTX for patients with LRGTN. Studies were full-text screened for quality assessment and data extraction. Eligible studies must have reported complete remission rate. A fixed-effects meta-analysis was conducted to quantify the efficacy and safety of Act-D and MTX on odds ratios (ORs) and 95% confidence intervals (95%CIs), respectively. Results A total of 8 RCTs and 9 non-RCTs (1674 patients) were included. In terms of efficacy, Act-D is superior to MTX in complete remission (80.2% [551/687] vs 65.1% [643/987]; OR 2.15, 95%CI 1.70 to 2.73). In the stratified analysis, patients from RCTs and non-RCTs both had a better complete remission from Act-D-based regimen (RCTs: 81.2% [259/319] vs 66.1% [199/301], OR 2.17, 95%CI 1.49 to 3.16; non-RCTs: 79.3% [292/368] vs 65.0% [444/686], OR 2.14, 95%CI 1.57 to 2.92). In terms of safety, patients receiving Act-D had higher risks of suffering nausea (OR 2.35, 95%CI 1.68 to 3.27), vomiting (OR 2.40, 95%CI 1.63 to 3.54), and alopecia (OR 2.76, 95%CI 1.60 to 4.75). Notably, liver toxicity (OR 0.38, 95%CI 0.19 to 0.76) was the only one that was conformed to have a higher risk for patients receiving MTX. In addition, the pooled results showed no significant difference of anaemia, leucocytopenia, neutropenia, thrombocytopnia, constipation, diarrhea, anorexia, and fatigue between Act-D and MTX. Conclusions Our meta-analysis suggests that Act-D had better efficacy profile in general, and MTX had less toxicities in LRGTN. Future clinical trials should be better orchestrated to provide more valid data on efficacy and toxicity.

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Section: Studies Selection and Characteristicsmentioning

confidence: 99%

Direct comparisons of efficacy and safety between actinomycin-D and methotrexate in women with low-risk gestational trophoblastic neoplasia: a meta-analysis of randomized and high-quality non-randomized studies

et al. 2021

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“…In some Australian centres, actinomycin D may be preferred, due to geographical barriers to accessing multi-day treatments. 12 Established risk factors for treatment resistance include increasing WHO risk score, clinicopathological diagnosis of choriocarcinoma, higher pre-treatment HCG and presence of metastatic disease. 13,14 In our cohort, patients with WHO risk scores of 5-6 had a significantly higher rate of treatment resistance following methotrexate, with only 45.5% (5/11) of the patients in this subgroup responding to this treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Access and geographic location are likely to have a significant impact on an individual's decision. In some Australian centres, actinomycin D may be preferred, due to geographical barriers to accessing multi‐day treatments 12 …”

Section: Discussionmentioning

confidence: 99%

Low‐risk gestational trophoblastic neoplasia – 20 years experience of a state registry

McInerney,

McNally,

Cade

et al. 2023

Aust NZ J Obst Gynaeco

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BackgroundGestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy.AimsTo report the experience of a statewide registry in the treatment of low‐risk gestational trophoblastic neoplasia (GTN) over a 20‐year period.Materials and MethodsA retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low‐risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed.ResultsThe incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0–29 days). Seventy‐seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi‐agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5–6 (odds ratio (OR) 6.56, 95% CI 1.73–24.27, P = 0.005) and those with pre‐treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73–24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry.ConclusionsMethotrexate is a highly effective treatment for low‐risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5–6 requires further investigation.

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“…After full-text screening, we ultimately included 17 studies that met the eligibility criteria in the present analysis: 8 RCTs [6, 19-25] and 9 non-RCTs [26][27][28][29][30][31][32][33][34]. The ow diagram in Fig.…”

Section: Studies Selection and Characteristicsmentioning

confidence: 99%

Direct Comparisons of Efficacy and Safety Between Actinomycin-D and Methotrexate in Women With Low-Risk Gestational Trophoblastic Neoplasia: A Systematic Review and Meta-Analysis

Hao

Zhou

Zhang

et al. 2021

Preprint

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Background: Actinomycin-D (Act-D) and Methotrexate (MTX) are both effective first-line agents for low-risk gestational trophoblastic neoplasia (LRGTN) with no consensus regarding which is more effective or less toxic. The primary objective of this meta-analysis is to compare Act-D with MTX in the treatment of LRGTN.Methods: We systematically searched electronic databases, conferences abstracts and trial registries for randomized controlled trials (RCTs) and high-quality non-randamized controlled trials (non-RCTs), comparing Act-D with MTX for patients with LRGTN. Studies were full-text screened for quality assessment and data extraction. Eligible studies must have reported complete remission rate. A fixed-effects meta-analysis was conducted to quantify the efficacy and safety of Act-D and MTX on odds ratios (ORs) and 95% confidence intervals (95%CIs), respectively.Results: A total of 8 RCTs and 9 non-RCTs (1674 patients) were included. In terms of efficacy, Act-D is superior to MTX in complete remission (OR 2.15, 95%CI 1.70 to 2.73). In the stratified analysis, patients from RCTs and non-RCTs both had a better CR from Act-D-based regimen (RCTs: OR 2.17, 95%CI 1.49 to 3.16; non-RCTs: OR 2.14, 95%CI 1.57 to 2.92). In terms of safety, patients receiving Act-D had higher risks of suffering nausea (OR 2.35, 95%CI 1.68 to 3.27), vomiting (OR 2.40, 95%CI 1.63 to 3.54), and alopecia (OR 2.76, 95%CI 1.60 to 4.75). Notably, liver toxicity (OR 0.38, 95%CI 0.19 to 0.76) was the only one that was conformed to have a higher risk for patients receiving MTX. In addition, the pooled results showed no significant difference of anaemia, leucocytopenia, neutropenia, thrombocytopnia, constipation, diarrhea, anorexia, and fatigue between Act-D and MTX.Conclusions: Our meta-analysis suggests that Act-D had better efficacy profile in general, and MTX had less toxicities in LRGTN. Future clinical trials should be better orchestrated to provide more valid data on efficacy and toxicity.

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Outcomes of women diagnosed and treated for low‐risk gestational trophoblastic neoplasia at the Queensland Trophoblast Centre (QTC)

Abstract: All women were successfully treated and achieved complete remission. Changing from MTX to actinomycin D as first-line chemotherapy for women with low-risk GTN was feasible and safe.

Cited by 6 publications

References 23 publications

Direct comparisons of efficacy and safety between actinomycin-D and methotrexate in women with low-risk gestational trophoblastic neoplasia: a meta-analysis of randomized and high-quality non-randomized studies

Direct comparisons of efficacy and safety between actinomycin-D and methotrexate in women with low-risk gestational trophoblastic neoplasia: a meta-analysis of randomized and high-quality non-randomized studies

Low‐risk gestational trophoblastic neoplasia – 20 years experience of a state registry

Direct Comparisons of Efficacy and Safety Between Actinomycin-D and Methotrexate in Women With Low-Risk Gestational Trophoblastic Neoplasia: A Systematic Review and Meta-Analysis

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