Results with Floxuridine, Actinomycin D, Etoposide, and Vincristine in Gestational Trophoblastic Neoplasias with International Federation of Gynecology and Obstetrics Scores ≥5

Abstract

Background. 5-fluorouracil-based multiagent chemotherapy has been used as the primary treatment for high-risk gestational trophoblastic neoplasia (GTN) in China for a few decades. This study aims to assess the efficacy and toxicity of floxuridine, actinomycin D, etoposide, and vincristine (FAEV) as primary treatment for patients with GTN who had International Federation of Gynecology and Obstetrics (FIGO) scores ≥5. Methods. A total of 207 patients with GTN who had FIGO scores ≥5 were treated with FAEV as first-line chemotherapy at Peking Union Medical College Hospital between January 2002 and December 2017. Complete remission (CR), resistance, survival, toxicity, and reproductive outcomes were analyzed. Results. Of the 207 patients treated with FAEV, 9 (4.3%) required a change of chemotherapy owing to toxicity and 1 (0.5%) died of cerebral hernia 5 weeks after commencing treatment. The remaining 197 patients were assessable to determine the response to FAEV; among them, 168 (85.3%) achieved CR with FAEV and 29 (14.7%) developed resistance to FAEV. The 5-year overall survival rate of the entire cohort was 97.4%. Grade 3-4 neutropenia, thrombocytopenia, and anemia occurred in 28.4%, 6.8%, and 6.2% of cycles, respectively. No acute toxicity-related deaths occurred. Five patients developed acute myeloid leukemia 10-50 months after exposure to chemotherapy; another patient developed duodenal cancer 2 years after completing therapy. Sixty-one patients who preserved fertility wanted to become pregnant; 56 of them conceived. Conclusion.The FAEV regimen is an effective primary treatment for patients with GTN who have FIGO scores ≥5, and has predictable and manageable toxicity. The Oncologist 2021;9999:• • Implications for Practice: The most commonly used multiagent chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) is EMA/CO worldwide. However, 5-fluorouracil-based multiagent chemotherapy has been used as the primary treatment for high-risk GTN in China for a few decades. This study evaluated the efficacy and toxicity of FAEV as a primary treatment for patients with GTN who have FIGO scores ≥5. Our data demonstrated that FAEV as primary treatment achieved favorable outcomes for patients with FIGO scores ≥5. Toxicities that result from the FAEV regimen are predictable and manageable. The FAEV regimen may provide another option for the treatment of GTN.

Management of liver and brain metastases in ultra-high-risk patients with gestational trophoblastic neoplasia: a single-center experience

“…Ten patients among 11 ultra-high-risk GTN patients with liver or brain metastases were treated with EMA-CO as first-line chemotherapy in our study. The results were consistent with previous studies, showing that the most commonly used multiple-agent chemotherapy for high-risk GTN worldwide remains the EMA-CO protocol 6,11,14,19,[23][24][25] , which is considered to have the best effectiveness-to-toxicity ratio 13 . The cumulative 5-year survival rate of patients given EMA-CO is between 75% and 90% 4,19 .…”

The efficacy and safety of 5-fluorouracil/cisplatin/vincristine as a multi-agent chemotherapy regimen in gestational trophoblastic neoplasia

“…This finding is consistent with those of the previous studies. In a retrospective study of Li et al, grade 3-4 neutropenia occurred in 28.4% of cycles (17). Fortunately, all grade 3/4 AEs successfully recovered with supportive treatment, and no chemotherapy delay over 3 weeks or deaths occurred.…”

“…Li et al investigated the efficacy of chemotherapy based on 5-FU regimen (FAV and FA) as the initial chemotherapy regimen for the treatment of high-risk GTN and found a CR rate of 87.4% (16). A retrospective study of FAEV regimen in the first-line chemotherapy of patients with GTN who had FIGO scores ≥5 reported a CR rate of 85.3% (168/207) and a 5-year overall survival rate of 97.4% (17). Furthermore, the differences in the 5-year overall survival and disease-free survival between the two groups were not statistically significant (p = 0.760 and p = 0.754, respectively).…”

Combining serum peptide signatures with International Federation of Gynecology and Obstetrics (FIGO) risk score to predict the outcomes of patients with gestational trophoblastic neoplasia (GTN) after first-line chemotherapy

“…A prospective collection of peripheral blood of patients with treatment-naïve GTN were conducted within 7 days before the initial therapy at 5 centers from June 2017 to June 2019. Based on FIGO cancer Report and clinical practice in China about management of gestational trophoblastic disease (2,(12)(13)(14), single-agent dactinomycin chemotherapy was prescribed as firstline treatment for low-risk GTN (FIGO score of less than 5) and multiagent chemotherapy using 5-FU based regimen or EMACO as first-treatment for low-risk GTN with FIGO score 5-6 or high-risk GTN. Chemotherapy response during first-line therapy was monitored by hCG assay at the start of each treatment cycle.…”