Difference between revisions of "Gestational trophoblastic neoplasia"
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Revision as of 02:37, 26 September 2020
| Section editor | |
|---|---|
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Summer B. Dewdney, MD Rush University Chicago, IL |
4 regimens on this page
6 variants on this page
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Guidelines
ESMO
- 2013: Seckl et al. Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
NCCN
Low-risk disease, all lines of therapy
Dactinomycin monotherapy
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Regimen
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Osathanondh et al. 1975 | 1965-1973 | Non-randomized (RT) | ||
| Osborne et al. 2011 (GOG 0174) | 1999-2007 | Phase III (E-switch-ic) | Methotrexate | Seems to have superior CR rate |
Chemotherapy
- Dactinomycin (Cosmegen) 1.25 mg/m2 IV push once on day 1
14-day cycles "until the βhCG assay had reached the institutional normal, or until either a rise or plateau in the βhCG level was observed"
References
- Osathanondh R, Goldstein DP, Pastorfide GB. Actinomycin D as the primary agent for gestational trophoblastic disease. Cancer. 1975 Sep;36(3):863-6. link to original article PubMed
- GOG 0174: Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, Provencher D, Scott Miller D, Covens AL, Lage JM. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Mar 1;29(7):825-31. Epub 2011 Jan 24. link to original article link to PMC article contains verified protocol PubMed
EMA-CO
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EMA-CO: Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Oncovin (Vincristine)
Regimen
| Study | Years of enrollment | Evidence |
|---|---|---|
| Newlands et al. 1991 | 1979-1989 | Non-randomized (RT) |
Chemotherapy
- Etoposide (Vepesid)
- Methotrexate (MTX)
- Dactinomycin (Cosmegen)
- Cyclophosphamide (Cytoxan)
- Vincristine (Oncovin)
References
- Newlands ES, Bagshawe KD, Begent RH, Rustin GJ, Holden L. Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989. Br J Obstet Gynaecol. 1991 Jun;98(6):550-7. link to original article PubMed
Mercaptopurine & Methotrexate
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Regimen
| Study | Evidence |
|---|---|
| Li et al. 1958 | Pilot |
Note: this is of historic interest.
Chemotherapy
References
- Li MC, Hertz R, Bergenstal DM. Therapy of choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists. N Engl J Med. 1958 Jul 10;259(2):66-74. link to original article PubMed
Methotrexate monotherapy
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Regimen
| Study | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|
| Li et al. 1956 | Pilot | ||
| Li et al. 1958 | Pilot | ||
| Homesley et al. 1988 | Phase II | ||
| Osborne et al. 2011 (GOG 0174) | Phase III (C) | Dactinomycin | Seems to have inferior CR rate |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Methotrexate (MTX) 30 mg/m2 IM once on day 1
7-day cycles "until the βhCG assay had reached the institutional normal, or until either a rise or plateau in the βhCG level was observed"
References
- Li MC, Hertz R, Spencer DB. Effect of methotrexate therapy upon choriocarcinoma and chorioadenoma. Proc Soc Exp Biol Med. 1956 Nov;93(2):361-6. link to original article PubMed
- Li MC, Hertz R, Bergenstal DM. Therapy of choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists. N Engl J Med. 1958 Jul 10;259(2):66-74. link to original article PubMed
- Homesley HD, Blessing JA, Rettenmaier M, Capizzi RL, Major FJ, Twiggs LB. Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic disease. Obstet Gynecol. 1988 Sep;72(3 Pt 1):413-8. link to original article PubMed
- GOG 0174: Osborne RJ, Filiaci V, Schink JC, Mannel RS, Alvarez Secord A, Kelley JL, Provencher D, Scott Miller D, Covens AL, Lage JM. Phase III trial of weekly methotrexate or pulsed dactinomycin for low-risk gestational trophoblastic neoplasia: a Gynecologic Oncology Group study. J Clin Oncol. 2011 Mar 1;29(7):825-31. Epub 2011 Jan 24. link to original article link to PMC article contains verified protocol PubMed